title: Randomized controlled trial of noninvasive positive pressure ventilation (NPPV) versus servoventilation in patients with CPAP-induced central sleep apnea (complex sleep apnea).
abstract: OBJECTIVE
  To compare the treatment effect of noninvasive positive pressure ventilation (NPPV) and anticyclic servoventilation in patients with continuous positive airway pressure (CPAP)-induced central sleep apnea (complex sleep apnea).
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Sleep center.
  
  
  METHODS
  Thirty patients who developed complex sleep apnea syndrome (CompSAS) during CPAP treatment.
  
  
  METHODS
  NPPV or servoventilation.
  
  
  RESULTS
  Patients were randomized to NPPV or servo-ventilation. Full polysomnography (PSG) was performed after 6 weeks. On CPAP prior to randomization, patients in the NPPV and servoventilator arm had comparable apnea-hypopnea indices (AHI, 28.6 ± 6.5 versus 27.7 ± 9.7 events/h (mean ± standard deviation [SD])), apnea indices (AI,19 ± 5.6 versus 21.1 ± 8.6 events/h), central apnea indices (CAI, 16.7 ± 5.4 versus 18.2 ± 7.1 events/h), oxygen desaturation indices (ODI,17.5 ± 13.1 versus 24.3 ± 11.9 events/h). During initial titration NPPV and servoventilation significantly improved the AHI (9.1 ± 4.3 versus 9 ± 6.4 events/h), AI (2 ± 3.1 versus 3.5 ± 4.5 events/h) CAI (2 ± 3.1 versus 2.5 ± 3.9 events/h) and ODI (10.1 ± 4.5 versus 8.9 ± 8.4 events/h) when compared to CPAP treatment (all P < 0.05). After 6 weeks we observed the following differences: AHI (16.5 ± 8 versus 7.4 ± 4.2 events/h, P = 0.027), AI (10.4 ± 5.9 versus 1.7 ± 1.9 events/h, P = 0.001), CAI (10.2 ± 5.1 versus 1.5 ± 1.7 events/h, P < 0.0001)) and ODI (21.1 ± 9.2 versus 4.8 ± 3.4 events/h, P < 0.0001) for NPPV and servoventilation, respectively. Other sleep parameters were unaffected by any form of treatment.
  
  
  CONCLUSIONS
  After 6 weeks, servoventilation treated respiratory events more effectively than NPPV in patients with complex sleep apnea syndrome.
authors.affiliation: Kloster Grafschaft, Pulmonary Medicine I, Home Mechanical Ventilation Unit and Sleep Laboratory, Schmallenberg, Germany. d.dellweg@fkkg.de
authors.forename: Dominic
authors.initials: D
authors.lastname: Dellweg
authors.forename: Jens
authors.initials: J
authors.lastname: Kerl
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Hoehn
authors.forename: Markus
authors.initials: M
authors.lastname: Wenzel
authors.forename: Dieter
authors.initials: D
authors.lastname: Koehler
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D020182:Sleep Apnea, Central / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy
keywords: CPAP; NPPV; central sleep apnea; complex sleep apnea; servo-ventilation
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