Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: “The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses”

Abstract

An update of the 2012 systematic review and meta-analyses were performed and a modified-GRADE approach was used to update the recommendation for the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnea syndrome (CSAS) related to congestive heart failure (CHF). Metaanalyses demonstrated an improvement in LVEF and a normalization of AHI in all patients. Analyses also demonstrated an increased risk of cardiac mortality in patients with an LVEF of ≤ 45% and moderate or severe CSA predominant sleep-disordered breathing. These data support a Standard level recommendation against the use of ASV to treat CHF-associated CSAS in patients with an LVEF of ≤ 45% and moderate or severe CSAS, and an Option level recommendation for the use of ASV in the treatment CHF-associated CSAS in patients with an LVEF > 45% or mild CHF-related CSAS. The application of these recommendations is limited to the target patient populations; the ultimate judgment regarding propriety of any specific care must be made by the clinician.

Advances in non‐invasive positive airway pressure technology

“…The mechanisms underlying these findings have not yet been fully explained, but do not appear to be related to adverse cardiac remodelling or worsening heart failure . These findings stimulated much discussion among clinicians and resulted in changes to guidelines around the management of CSA, advising against the use of ASV in adults with heart failure and moderate or severe CSA with an ejection fraction ≤45% . While most clinical and much research activity with ASV in patients with heart failure and reduced ejection fraction was ceased following the release of the SERVE‐HF results, the Effect of ASV on Survival and Hospital Admissions in HF (ADVENT‐HF) study continued patient recruitment following review by the trial's data and safety monitoring committee.…”

“…42 These findings stimulated much discussion among clinicians and resulted in changes to guidelines around the management of CSA, advising against the use of ASV in adults with heart failure and moderate or severe CSA with an ejection fraction ≤45%. 43 While most clinical and much research activity with ASV in patients with heart failure and reduced ejection fraction was ceased following the release of the SERVE-HF results, [44][45][46] the Effect of ASV on Survival and Hospital Admissions in HF (ADVENT-HF) study 47 continued patient recruitment following review by the trial's data and safety monitoring committee. This trial is evaluating a newer generation ASV device incorporating autotitrating EPAP and a different pressure support algorithm to the SERVE-HF study in patients with reduced ejection fraction and either CSA or OSA.…”

Complex sleep apnea syndrome

“…Полученные в итоге исследования SERVE-HF результаты стали поводом к принципиальным изменениям существующих взглядов на стандарты лечения центрального апноэ сна: АСВ не должна применяться для лечения пациентов с ХСН с фракцией выброса левого желудочка менее 45% и нарушениями дыхания во сне преимущественного центрального генеза [21]. Впрочем, это правило применимо только к пациентам с синдромом центрального апноэ сна на фоне систолической сердечной недостаточностью и их не следует экстраполировать на больных с другой сердечно-сосудистой патологией, а также на тех пациентов с ХСН, у которых проводится СиПАП-терапия как по поводу центрального, так и по поводу СОАС.…”

“…Суммируя имеющийся на сегодняшний день мировой [12,13,21] и собственный клинический опыт, можно сказать, что при возникновении Комп-САС следует продолжать начатую СиПАП-терапию (рис. 3).…”

Apnea central del sueño con patrón de respiración Cheynes-Stokes

“…Los últimos metaanálisis sobre el uso de servoventilación adaptativa, muestran aumento de la mortalidad en pacientes con falla cardiaca con fracción de eyección menor del 45% asociado a apnea central moderada o grave, por lo cual no se recomienda el uso de estos dispositivos en este grupo de pacientes (49).…”