title: Performance of conventional and enhanced adaptive servoventilation (ASV) in heart failure patients with central sleep apnea who have adapted to conventional ASV.
abstract: OBJECTIVE
  Adaptive servo-ventilation (ASV) is a positive pressure ventilator support system to normalize ventilation in patients with Cheyne-Stokes respiration (CSR). The latest generation enhanced ASV device (PaceWave; ResMed) has a new feature--auto-adjustment of EPAP. This study tested the hypothesis that enhanced ASV with auto-adjustment of EPAP (PaceWave) is non-inferior to conventional ASV (AutoSetCS).
  
  
  METHODS
  This prospective, randomized, crossover, single-center study enrolled adult patients with stable heart failure (HF) and moderate-to-severe sleep-disordered breathing (SDB) who had been receiving conventional ASV therapy for at least 4 weeks. Patients received conventional ASV for one night and enhanced ASV on another night. Support settings for the two ASV devices were similar, with fixed expiratory positive airway pressure (EPAP) set to between 4 and 10 cm H2O and variable EPAP set to between 4 and 15 cm H2O. Full polysomnography was performed during ASV therapy on both nights. Endpoints were the number of nocturnal respiratory events and oxygen desaturations, and changes in blood pressure (BP).
  
  
  RESULTS
  Levels of EPAP were comparable during the use of enhanced and conventional ASV, but minimum and maximum inspiratory pressure support values were significantly higher with the PaceWave device. All measures of apnea and hypopnea, and oxygen saturation, were significantly improved during ASV therapy with either device. There were no significant changes in BP or heart rate.
  
  
  CONCLUSIONS
  Enhanced ASV is non-inferior to ASV with fixed EPAP in patients with chronic HF and CSR, with a trend towards better control of respiratory events.
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, D-32545, Bad Oeynhausen, Germany, ooldenburg@hdz-nrw.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Oldenburg
authors.forename: Jens
authors.initials: J
authors.lastname: Spießhöfer
authors.forename: Henrik
authors.initials: H
authors.lastname: Fox
authors.forename: Natalie
authors.initials: N
authors.lastname: Prib
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
mesh_terms: D000328:Adult; D000368:Aged; D002639:Cheyne-Stokes Respiration / Q000175:diagnosis / Q000628:therapy*; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011446:Prospective Studies; D020182:Sleep Apnea, Central / Q000175:diagnosis / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome