title: Adaptive servo-ventilation as treatment of persistent central sleep apnea in post-acute ischemic stroke patients.
abstract: BACKGROUND
  Adaptive servo-ventilation (ASV) is a well-established treatment of central sleep apnea (CSA) related to congestive heart failure (CHF). Few studies have evaluated the effectiveness and adherence in patients with CSA of other etiologies, and even less is known about treatment of CSA in patients of post ischemic stroke.
  
  
  METHODS
  A single-centre retrospective analysis of ASV treatment for CSA in post-acute ischemic stroke patients without concomitant CHF was performed. Demographics, clinical data, sleep studies, ventilator settings, and adherence data were evaluated.
  
  
  RESULTS
  Out of 154 patients on ASV, 15 patients had CSA related to ischemic stroke and were started on ASV a median of 11 months after the acute cerebrovascular event. Thirteen out of the 15 patients were initially treated with continuous positive airway pressure (11/15) and bilevel positive airway pressure (2/15) therapy with unsatisfactory control of CSA. ASV significantly improved AHI (46.7 ± 24.3 vs 8.5 ± 12/h, P = 0.001) and reduced ESS (8.7 ± 5.7 vs 5.6 ± 2.5, P = 0.08) with a mean nightly use of ASV of 5.4 ± 2.4 h at 3 months after the initiation of treatment. Results were maintained at 6 months.
  
  
  CONCLUSIONS
  ASV was well tolerated and clinically effective in this group of patients with persistent CSA after ischemic stroke.
authors.affiliation: Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Switzerland. Electronic address: anne-kathrin.brill@insel.ch.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Brill
authors.affiliation: Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Switzerland.
authors.forename: Regula
authors.initials: R
authors.lastname: Rösti
authors.affiliation: Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Switzerland.
authors.forename: Jacqueline Pichler
authors.initials: JP
authors.lastname: Hefti
authors.affiliation: Department of Neurology, University Hospital (Inselspital) and University of Bern, Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassetti
authors.affiliation: Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gugger
authors.affiliation: Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Switzerland.
authors.forename: Sebastian R
authors.initials: SR
authors.lastname: Ott
mesh_terms: D002545:Brain Ischemia / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D020182:Sleep Apnea, Central / Q000150:complications / Q000628:therapy*; D020521:Stroke / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
keywords: Cerebrovascular insult; Continuous positive airway pressure; Epworth Sleepiness Scale; Neurologic disorders; Sleep disordered breathing; Stroke distribution