Background: Cheyne Stokes Breathing (CSB), a form of central sleep apnea is often found in medical illnesses such as heart failure, stroke or renal failure. Adaptive servo-ventilation (ASV) has been reported to be an effective treatment of CSB in heart failure. However, there are no reports about using ASV for idiopathic CSB, which is not associated with heart failure or other serious medical problems.
Case summary: We evaluated three patients with idiopathic CSB and examined the feasibility of using ASV to treat them. The patients had a periodic breathing pattern resembling Cheyne-Stokes Breathing. During polysomnography, the abnormal breathing pattern was present while patients were both awake and asleep. The patients were first tested on continuous positive airway pressure (CPAP) and/or oxygen; however they did not respond well to either of these treatments. They were then assessed on ASV. The mean abnormal breathing events index decreased from 35.2 to 3.5 per hour of sleep on ASV. There was a significant reduction in the mean number of arousals caused by abnormal breathing events: from 18.5 to 1.1 per hour of sleep. After six to twelve months of using ASV, the patients had maintained significant improvement in subjective daytime alertness and mood.
Conclusion: A trial of ASV for patients with idiopathic CSB is recommended if they do not have improvement in sleep respiration or daytime performance on CPAP and/or oxygen.