title: Home-use servo-ventilation therapy in chronic pain patients with central sleep apnea: initial and 3-month follow-up.
abstract: OBJECTIVE
  Opioid treatment of non-malignant chronic pain can result in hypoxemia, hypercarbia, and central sleep apnea. The aim of this study was to determine the initial efficacy of auto servo-ventilation (ASV) and after 3 months of home use.
  
  
  METHODS
  This prospective multicenter interventional study recruited chronic pain patients prescribed ≥100 morphine equivalents for at least 4 months.
  
  
  METHODS
  Following full-night polysomnography (PSG) to confirm the presence of sleep-disordered breathing, patients were randomized to three additional full-night-attended PSGs with continuous positive airway pressure (CPAP), ASV, and servo-ventilation with an initial mandatory pressure support of 6 cm H2O (ASV manual PSmin 6). Following the PSGs, patients were sent home with EncoreAnywhere and ASV with or without mandatory pressure support.
  
  
  RESULTS
  Based on the initial PSG studies, CPAP improved but did not normalize the apnea-hypopnea index (AHI), central apnea index (CAI), or hypopnea index (HI), as all remained elevated. Clinically significant reductions were noted after just one night of ASV and ASV manual (PSmin 6). After 3 months of ASV home use, the AHI, CAI, and obstructive apnea index (OAI) were significantly reduced when compared to baseline diagnostic levels and even when compared to respiratory disturbance indices with CPAP treatment.
  
  
  CONCLUSIONS
  Initial and home use of ASV for 3 months resulted in significantly lower AHI, CAI, and OAI. This reduction attests to the efficacy of ASV treatment in chronic pain patients on high doses of opioids.
authors: Department of Psychiatry, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 7 Main - 429, Toronto, Ontario, M5T 2S8, Canada.|Youthdale Treatment Centres, Toronto, Canada.
authors: Colin M
authors: CM
authors: Shapiro
authors: Department of Psychiatry, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 7 Main - 429, Toronto, Ontario, M5T 2S8, Canada. sachung@uhnres.utoronto.ca.|Youthdale Treatment Centres, Toronto, Canada. sachung@uhnres.utoronto.ca.
authors: Sharon A
authors: SA
authors: Chung
authors: Arkansas Center of Sleep Medicine, Little Rock, AR, USA.
authors: Paul E
authors: PE
authors: Wylie
authors: Department of Psychiatry, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 7 Main - 429, Toronto, Ontario, M5T 2S8, Canada.
authors: Naheed K
authors: NK
authors: Hossain
authors: Western Montana Clinic, Missoula, MT, USA.
authors: Rolf H O
authors: RH
authors: Holle
authors: NeuroTrials Research Inc., Atlanta, GA, USA.
authors: Russell P
authors: RP
authors: Rosenberg
authors: Clayton Sleep Institute, St. Louis, MO, USA.
authors: Mark J
authors: MJ
authors: Muehlbach
authors: Sleep Disorder Center of Alabama, Birmingham, AL, USA.
authors: Robert C
authors: RC
authors: Doekel
authors: Sleep Disorder Center of Alabama, Birmingham, AL, USA.
authors: G Vernon
authors: GV
authors: Pegram
authors: Philips Respironics, Monroeville, PA, USA.
authors: Jeffrey G
authors: JG
authors: Jasko
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000187:drug effects; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D020182:Sleep Apnea, Central / Q000139:chemically induced* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: ASV; Chronic pain; Opioids; Sleep-disordered breathing