Anticyclic modulated ventilation versus continuous positive airway pressure in patients with coexisting obstructive sleep apnea and Cheyne-Stokes respiration: a randomized crossover trial.
BACKGROUND
Although coexisting obstructive sleep apnea (OSA) and Cheyne-Stokes respiration (CSR) occur frequently in patients with heart diseases, optimal treatment remains unclear. Positive airway pressure (PAP) effectively treats OSA and adaptive servo-ventilation (ASV) has been shown to improve CSR. We compared a new treatment algorithm combining automatic continuous positive airway pressure (APAP) and ASV (anticyclic modulated ventilation, ACMV) versus continuous positive airway pressure (CPAP).


METHODS
Thirty-nine patients (35 male, four female; aged 65.5±9.7 years; body mass index, 31.0±5.9 kg/m2) with underlying heart disease and coexisting OSA and CSR were enrolled. After diagnostic polysomnography (PSG) and CPAP titration, patients were randomized either to CPAP or to ACMV for four weeks of treatment in a crossover design.


RESULTS
Total apnea-hypopnea index (AHI) was 49.0±18.8/h at baseline, 12.3±14.6/h with CPAP (P<0.001 vs baseline), and 3.7±5.6/h with ACMV (P<0.001 vs. baseline and vs. CPAP). Obstructive AHI was 20.7±14.4/h at baseline, 5.1±9.3/h with CPAP (P<0.001 vs. baseline), and 0.4±0.4/h with ACMV (P<0.001 vs. baseline and vs. CPAP). Central AHI was 28.3±13.4/h at baseline, 7.2±9.7/h with CPAP (P<0.001 vs baseline) and 3.3±5.4/h with ACMV (P<0.001 vs. baseline and vs. CPAP). Ejection fraction was increased significantly (from 38.6±15.6 to 44.4±12.2%) only with ACMV. Subjective sleepiness significantly improved only with CPAP whereas objective sleep quality and treatment adherence were not different between both treatment modalities.


CONCLUSIONS
ACMV is an effective treatment option in patients with coexisting OSA and CSR. It is superior to CPAP in reducing total AHI as well as obstructive and central AHI.
Krankenhaus der Augustinerinnen Cologne, Cologne, Germany; Institute for Pneumology at the University Witten/Herdecke, Solingen, Germany. Electronic address: wgaletke@koeln-kh-augustinerinnen.de.
Wolfgang
W
Galetke
Institute for Pneumology at the University Witten/Herdecke, Solingen, Germany.
Babak M
BM
Ghassemi
Institute for Pneumology at the University Witten/Herdecke, Solingen, Germany; Krankenhaus Bethanien Solingen, Solingen, Germany.
Christina
C
Priegnitz
Institute for Pneumology at the University Witten/Herdecke, Solingen, Germany; Krankenhaus Bethanien Solingen, Solingen, Germany.
Sven
S
Stieglitz
Institute for Pneumology at the University Witten/Herdecke, Solingen, Germany.
Norbert
N
Anduleit
Institute for Pneumology at the University Witten/Herdecke, Solingen, Germany.
Kerstin
K
Richter
Institute for Pneumology at the University Witten/Herdecke, Solingen, Germany; Krankenhaus Bethanien Solingen, Solingen, Germany.
Winfried J
WJ
Randerath
D000368:Aged; D000465:Algorithms; D002639:Cheyne-Stokes Respiration / Q000150:complications / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000379:methods; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods; D008297:Male; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*
Adaptive servo-ventilation; Anticyclic modulated ventilation; Cheyne–Stokes respiration; Coexisting sleep-disordered breathing; Continuous positive airway pressure; Obstructive sleep apnea