Whom are we treating with adaptive servo-ventilation? A clinical post hoc analysis

Malfertheiner, Maximilian; Lerzer, C.; Kolb, Leonie; Heider, Katharina; Zeman, Florian; Gfüllner, Florian; Maier, Lars S.; Pfeifer, Michael; Arzt, Michael

doi:10.1007/s00392-017-1112-3

Cited by 22 publications

(30 citation statements)

References 38 publications

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“…The ASV population described differs from previous reports, which either focus on CHF (9, 31), or on specific neurological disorders (Chiari malformation (32), Multiple System Atrophy (33), opiate or other drug toxicities (16,21,22,34,35). Two retrospective studies (25,26) describe relatively large populations under ASV. Carnevale et al (25) included 74 patients: 33 with CHF and 41 with various neurological disorders or idiopathic CSA.…”

Section: Discussionmentioning

confidence: 90%

“…A German study analyzed 285 patients receiving ASV and undergoing diagnostic polysomnography (PSG). The most common indications were CHF and emergent CSA (67%), CSA in CHF (22%), idiopathic CSA (10%), and drug-induced CSA (0.4%) (26). The patients described in our study are long term users of ASV [median 40 months, IQR (22; 62)] which suggests at least a subjective benefit (although no formal assessment of health-related quality of life or symptom score were performed during this study).…”

Section: Discussionmentioning

confidence: 99%

“…Finally, we recorded echocardiographic data only in patients corresponding to the SERVE-HF trial inclusion criteria (i.e., subjects with "de novo" CSA excluding patients under prior CPAP and thus ESA) (9) to determine to what extent patients with a LVEF <45% in this specific group of ASV users were still being treated. Because left ventricular dysfunction and chronic heart failure have also been documented in patients with emergent sleep apnea (ESA), the prevalence of cardiac dysfunction in the ASV population studied may be underestimated (26,31,44). Indeed 13% of ESA patients had a history of chronic heart failure and cardiovascular risk factors were highly prevalent.…”

Section: Discussionmentioning

confidence: 99%

“…Very little information exists as to the present use of ASV in clinical practice in an unselected population (5,(25)(26)(27). The following study aims to describe the use of ASV in clinical practice in all patients within an area with a longstanding experience in home non-invasive ventilation (NIV) and treatment of sleep-disordered breathing (SDB) (28).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Cantero¹,

Adler

Pasquina

et al. 2020

Front. Med.

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“…In most TECSA cases, apnea events during initial PAP titration are self-limited and disappear overtime [6,13]. A follow-up is needed to make sure that the emergent central events disappear with continued therapy.…”

Section: Treatmentmentioning

confidence: 99%

Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

BaHammam

2017

Sleep Vigilance

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Treatment-emergent central sleep apnea (TECSA) is a distinct form of sleep-disordered breathing characterized by the development of central sleep apnea during the initiation of positive airway pressure (PAP) therapy in patients with obstructive sleep apnea. The exact mechanisms of TECSA are not clearly known; however, several theories have been proposed. Usually, TECSA is transient and self-limited, and disappears after continued PAP use. Nevertheless, patients with persistent TECSA have lower adherence to PAP therapy and are more likely to terminate therapy. Close follow up is necessary to assure that the emergent central events disappear with continued therapy. In patients with persistent TECSA, more advanced algorithms such as adaptive servo-ventilation have been shown to be very effective. In this brief review, we summarize the definition, prevalence, predictors, pathophysiology, and treatment approaches of TECSA.

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Treatment-Emergent Central Sleep Apnea: Always Look for an Air Leak

Pirzada

BaHammam

2022

Teaching Pearls in Noninvasive Mechanical Ventilation

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Whom are we treating with adaptive servo-ventilation? A clinical post hoc analysis

Abstract: Clinical usage of ASV changed for a small subgroup of patients after release of the SERVE-HF results. Nevertheless, ASV treatment should be monitored and evaluated with diligence in the reminder indications.

Cited by 22 publications

References 38 publications

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

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

Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

Treatment-Emergent Central Sleep Apnea: Always Look for an Air Leak

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