title: Combined adaptive servo-ventilation and automatic positive airway pressure (anticyclic modulated ventilation) in co-existing obstructive and central sleep apnea syndrome and periodic breathing.
abstract: BACKGROUND
  The co-existence of obstructive and central sleep apnea/hypopnea syndrome (OSAS) and periodic breathing is common in patients with and without underlying heart diseases. While automatic continuous positive airway pressure (APAP) has proven to effectively treat OSAS, the adaptive servo-ventilation (ASV) sufficiently improves periodic breathing. This is the first trial on a device which combines both treatment modes.
  
  
  METHODS
  Pilot study on a two-week treatment in patients with co-existing obstructive and central and periodic breathing disturbances during sleep. Twelve consecutive patients (9 male, 3 female, age 56.9+/-10.6 years, BMI 32.4+/-5.5 kg/m(2)) were treated with a new algorithm which combines APAP and ASV (also called anticyclic modulated ventilation (ACMV), SOMNOventCR, Weinmann, Hamburg, Germany). Seven suffered from arterial hypertension, coronary heart disease and mitral regurgitation, none from congestive heart failure.
  
  
  RESULTS
  The total apnea-hypopnea index (AHI) improved from 43.8+/-24.0/h to 2.1+/-2.4 (p<0.01), the obstructive AHI from 12.8+/-14.3/h to 0.3+/-0.6/h (p<0.01) and the central AHI from 31.0+/-17.5/h to 1.7+/-2.0/h (p<0.01). Moreover, there was a significant improvement in the total number of arousals, respiratory induced arousals, oxygen saturation and sleep profile.
  
  
  CONCLUSIONS
  The algorithm combining automatic continuous positive airway pressure (CPAP) and ASV normalizes all types of co-existing obstructive and central apnea/hypopnea and periodic breathing.
authors.affiliation: Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhöherstrasse 169-175, Solingen, Germany. randerath@klinik-bethanien.de
authors.forename: Winfried J
authors.initials: WJ
authors.lastname: Randerath
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Galetke
authors.forename: Marlene
authors.initials: M
authors.lastname: Kenter
authors.forename: Kerstin
authors.initials: K
authors.lastname: Richter
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schäfer
mesh_terms: D000368:Aged; D000465:Algorithms; D002639:Cheyne-Stokes Respiration / Q000628:therapy; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation* / Q000379:methods*; D045853:Exhalation; D005260:Female; D006801:Humans; D001239:Inhalation; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen