Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes.
BACKGROUND
Complex sleep apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV.


METHODS
Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center.


RESULTS
ASV titration was performed for CompSAS (63%), CSA (22%), or CSA/Cheyne Stokes breathing patterns (15%). The median diagnostic sleep apnea hypopnea index (AHI) was 48 events per hour (range, 24 to 62). With CPAP, obstructive apneas decreased, but the appearance of central apneas maintained the AHI at 31 events per hour (range, 17 to 47) [p = 0.02]. With bilevel positive airway pressure (BPAP) in spontaneous mode, AHI trended toward worsening vs baseline, with a median of 75 events per hour (range, 46 to 111) [p = 0.055]. BPAP with a backup rate improved the AHI to 15 events per hour (range, 11 to 31) [p = 0.002]. Use of ASV dramatically improved the AHI to a mean of 5 events per hour (range, 1 to 11) vs baseline and vs CPAP (p < 0.0001). ASV also resulted in an increase in rapid eye movement sleep vs baseline and CPAP (18% vs 12% and 10%, respectively; p < 0.0001). Overall, 64 patients responded to the ASV treatment with a mean AHI < 10 events per hour. Of the 44 successful survey follow-up patients contacted, 32 patients reported some improvement in sleep quality.


CONCLUSIONS
The ASV device appears to be an effective treatment of both CompSAS and CSA syndromes that are resistant to CPAP.
Allam
Joanne Shirine
JS
Division of Pulmonary and Critical Care Medicine and Mayo Clinic Sleep Disorders Center, 200 First St SW, Rochester, MN 55905, USA.
Olson
Eric J
EJ
Gay
Peter C
PC
Morgenthaler
Timothy I
TI
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012189:Retrospective Studies; D020182:Sleep Apnea, Central / Q000175:diagnosis / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome