title: A novel adaptive servoventilation (ASVAuto) for the treatment of central sleep apnea associated with chronic use of opioids.
abstract: OBJECTIVE
  To compare the efficacy and patient comfort of a new mode of minute ventilation-targeted adaptive servoventilation (ASVAuto) with auto-titrating expiratory positive airway pressure (EPAP) versus bilevel with back-up respiratory rate (bilevel-ST) in patients with central sleep apnea (CSA) associated with chronic use of opioid medications.
  
  
  METHODS
  Prospective, randomized, crossover polysomnography (PSG) study. Eighteen consecutive patients (age ≥ 18 years) who had been receiving opioid therapy (≥ 6 months), and had sleep disordered breathing with CSA (central apnea index [CAI] ≥ 5) diagnosed during an overnight sleep study or positive airway pressure (PAP) titration were enrolled to undergo 2 PSG studies-one with ASVAuto and one with bilevel-ST. Patients completed 2 questionnaires after each PSG; Morning After Patient Satisfaction Questionnaire and PAP Comfort Questionnaire.
  
  
  RESULTS
  Patients had a mean age of 52.9 ± 15.3 years. PSG prior to randomization showed an apnea hypopnea index (AHI) of 50.3 ± 22.2 and CAI of 13.0 ± 18.7. Titration with ASVAuto versus bilevel-ST showed that there were significant differences with respect to AHI and CAI. The AHI and CAI were significantly lower on ASVAuto than bilevel-ST (2.5 ± 3.5 versus 16.3 ± 20.9 [p = 0.0005], and 0.4 ± 0.8 versus 9.4 ± 18.8 [p = 0.0002], respectively). Respiratory parameters were normalized in 83.3% of patients on ASVAuto versus 33.3% on bilevel-ST. Patients felt more awake and alert on ASVAuto than bilevel-ST based on scores from Morning After Patient Satisfaction Questionnaire (p = 0.0337).
  
  
  CONCLUSIONS
  The ASVAuto was significantly more effective than bilevel-ST for the treatment of CSA associated with chronic opioid use.
authors.affiliation: Stanford Sleep Medicine, Stanford University School of Medicine, Redwood City, CA;
authors.forename: Michelle
authors.initials: M
authors.lastname: Cao
authors.affiliation: Stanford Sleep Medicine, Stanford University School of Medicine, Redwood City, CA;
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Cardell
authors.affiliation: Willes Consulting Group Inc, Encinitas, CA;
authors.forename: Leslee
authors.initials: L
authors.lastname: Willes
authors.affiliation: ResMed Science Center, ResMed Corp., San Diego, CA.
authors.forename: June
authors.initials: J
authors.lastname: Mendoza
authors.affiliation: ResMed Science Center, ResMed Corp., San Diego, CA.
authors.forename: Adam
authors.initials: A
authors.lastname: Benjafield
authors.affiliation: Stanford Sleep Medicine, Stanford University School of Medicine, Redwood City, CA;
authors.forename: Clete
authors.initials: C
authors.lastname: Kushida
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D017286:Polysomnography; D016037:Single-Blind Method; D020182:Sleep Apnea, Central / Q000139:chemically induced / Q000628:therapy*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: ASV; CSA; adaptive servoventilation; bilevel; bilevel-ST; central sleep apnea; opioids; positive airway pressure; sleep apnea