Adaptive servo-ventilation in patients with coexisting obstructive sleep apnoea/hypopnoea and Cheyne-Stokes respiration

Sleep Med. 2008 Dec;9(8):823-30. doi: 10.1016/j.sleep.2008.02.011. Epub 2008 Jul 21.

Abstract

Objective: The coexistence of obstructive (OSAS) and central sleep apnoea (CSA) and Cheyne-Stokes respiration (CSR) is common in patients with and without underlying heart diseases. CPAP has been shown to improve CSA/CSR by about 50%, but recent data suggest maximal suppression of CSA is important in improving clinical outcomes in heart failure patients. Adaptive servo-ventilation (ASV) effectively suppresses CSA/CSR in heart failure, but only few trials have considered patients with coexisting OSAS and CSA/CSR.

Methods: Prospective, observational pilot study to evaluate the efficacy of a new ASV device, the BiPAP AutoSV, in 10 male consecutive patients with coexisting OSAS and CSA/CSR with and without heart failure over eight weeks. Six had stable heart failure.

Measurements and results: The total AHI improved from 48.9+/-20.6/h to 8.7+/-7.4, the obstructive AHI from 15.8+/-16.2/h to 2.6+/-2.5/h and the central AHI from 33.1+/-10.8/h to 6.1+/-5.9/h (all p<0.01). Furthermore, there was a significant improvement in sleep profile and respiratory related arousals. The six patients with cardiovascular disease, including three with congestive heart failure, showed similar improvements in all parameters.

Conclusions: BiPAP AutoSV was effective in reducing all types of respiratory disturbances in coexisting OSAS and CSA/CSR with and without heart failure. Further studies comparing the long-term clinical efficacy of this device against CPAP are warranted.

MeSH terms

  • Adaptation, Physiological*
  • Aged
  • Cheyne-Stokes Respiration / epidemiology*
  • Cheyne-Stokes Respiration / physiopathology*
  • Continuous Positive Airway Pressure / methods*
  • Heart Failure / epidemiology
  • Humans
  • Hypertension / epidemiology
  • Male
  • Middle Aged
  • Pilot Projects
  • Polysomnography
  • Prospective Studies
  • Pulmonary Ventilation
  • Sleep Apnea, Central / epidemiology*
  • Sleep Apnea, Central / therapy*
  • Sleep Apnea, Obstructive / epidemiology*
  • Sleep Apnea, Obstructive / therapy*