Comparison of Physiological Performance of Four Adaptive Servo Ventilation Devices in Patients with Complex Sleep Apnea

Knitter, James R.; Bailey, Omavi; Poongkunran, Chithra; Martinez, Aylene Flores; Martínez, L Chávez; Kobayashi, Ume; Combs, Daniel; Lane, Richard D.; Zaręba, Wojciech; Parthasarathy, Sairam

doi:10.1164/rccm.201807-1303le

Cited by 21 publications

(17 citation statements)

References 12 publications

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“…Knitter et al previously attempted to describe MV differences between ASV-F and ASV-V devices in TECSA patients with preserved LVEF [ 4 ]. The latter study consisted of a randomized cross-over study comparing 4 devices (each used for one night only) and concluded that the ResMed S7 VPAP Adapt (an ASV-V device) was associated with a higher MV than ASV-F devices.…”

Section: Discussionmentioning

confidence: 99%

“…To limit this risk, a multicentre design without predefined ASV-rules or ASV-brand requirements was used. An important further limitation results from the impossibility of making direct comparisons between ASV-F and ASV-V. Because of our long-term design, it was impossible for us to deploy an independent pneumotachograph MV and therapeutic pressure measures, and we therefore used manufacturer software as in previous clinical publications [ 4 , 28 ]. However, based on the ASV bench-study published by Zhu et al [ 2 ], which used an independent pneumotachograph and demonstrated device-differences in MV and therapeutic pressures, one can assume that such machine related heterogeneity exists in real life.…”

Section: Discussionmentioning

confidence: 99%

“…Adaptive Servo-Ventilation (ASV) is a non-invasive ventilatory therapy that provides positive expiratory airway pressure and inspiratory pressure support based on servo-controlled-flow or -volume monitoring [ 1 – 4 ]. At the beginning of the 2000s, ASV was mainly developed for the treatment of central sleep apnea (CSA) associated with Chronic Heart Failure (CHF) and reduced Left Ventricular Ejection Fraction (LVEF, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!

et al. 2020

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Backgrounds To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p < 0.001). MV differences between ASV-F (p = 0.002) and ASV-V (p < 0.001) were not homogenously distributed across clusters, suggesting specific cluster and ASV-algorithm interactions. Individual ASV-data suggest that the hyperventilation risk is not related to the cluster nor the ASV-monitoring type. Conclusions Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!

et al. 2020

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“…Physiological studies suggest that algorithm might play a role. However, we do not have data to demonstrate that these acute physiological measurements translate into significant impact on outcomes [49].…”

Section: Challenges In Managing Csa/periodic Breathing In Chf With Rementioning

confidence: 86%

Central sleep apnoea and periodic breathing in heart failure: prognostic significance and treatment options

et al. 2019

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Central sleep apnoea (CSA) including periodic breathing is prevalent in more than one-third of patients with heart failure and is highly and independently associated with poor outcomes. Optimal treatment is still debated and well-conducted studies regarding efficacy and impact on outcomes of available treatment options are limited, particularly in cardiac failure with preserved ejection fraction. While continuous positive airway pressure and oxygen reduce breathing disturbances by 50%, adaptive servoventilation (ASV) normalises breathing disturbances by to controlling the underlying mechanism of CSA. Results are contradictory regarding impact of ASV on hard outcomes. Cohorts and registry studies show survival improvement under ASV, while secondary analyses of the large SERVE-HF randomised trial showed an excess mortality in cardiac failure with reduced ejection fraction. The current priority is to understand which phenotypes of cardiac failure patients may benefit from treatment guiding individualised and personalised management.

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“…Some devices targeted a minute ventilation set at 90% of spontaneous ventilation to allow nocturnal PaCO 2 to increase slightly above the apnea threshold (3). Since their original design, options such as auto-titration of EPAP, of pressure support, and of back-up respiratory rate (BURR) have been added to the initial algorithms (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Adaptive Servo-Ventilation: A Comprehensive Descriptive Study in the Geneva Lake Area

Cantero¹,

Adler

Pasquina

et al. 2020

Front. Med.

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Background: Use of adaptive servo-ventilation (ASV) has been questioned in patients with central sleep apnea (CSA) and chronic heart failure (CHF). This study aims to detail the present use of ASV in clinical practice. Methods: Descriptive, cross-sectional, multicentric study of patients undergoing long term (≥3 months) ASV in the Cantons of Geneva or Vaud (1,288,378 inhabitants) followed by public or private hospitals, private practitioners and/or home care providers. Results: Patients included (458) were mostly male (392; 85.6%), overweight [BMI (median, IQR): 29 kg/m 2 (26; 33)], comorbid, with a median age of 71 years (59-77); 84% had been treated by CPAP before starting ASV. Indications for ASV were: emergent sleep apnea (ESA; 337; 73.6%), central sleep apnea (CSA; 108; 23.6%), obstructive sleep apnea (7; 1.5%), and overlap syndrome (6; 1.3%). Origin of CSA was cardiac (n = 30), neurological (n = 26), idiopathic (n = 28), or drug-related (n = 22). Among CSA cases, 60 (56%) patients had an echocardiography within the preceding 12 months; median left ventricular ejection fraction (LVEF) was 62.5% (54-65); 11 (18%) had a LVEF ≤45%. Average daily use of ASV was [mean (SD)] 368 (140) min; 13% used their device <3:30 h. Based on ventilator software, apnea-hypopnea index was normalized in 94% of subjects with data available (94% of 428). Conclusions: Use of ASV has evolved from its original indication (CSA in CHF) to a heterogeneous predominantly male, aged, comorbid, and overweight population with mainly ESA or CSA. CSA in CHF represented only 6.5% of this population. Compliance and correction of respiratory events were satisfactory.

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Comparison of Physiological Performance of Four Adaptive Servo Ventilation Devices in Patients with Complex Sleep Apnea

Abstract: NL, et al. E-cigarette use results in suppression of immune and inflammatory-response genes in nasal epithelial cells similar to cigarette smoke.

Cited by 21 publications

References 12 publications

Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!

Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!

Central sleep apnoea and periodic breathing in heart failure: prognostic significance and treatment options

Adaptive Servo-Ventilation: A Comprehensive Descriptive Study in the Geneva Lake Area

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