Adaptive servo-ventilation for the treatment of central sleep apnea in congestive heart failure: What have we learned?

Current Opinion in Pulmonary Medicine

Volumn 20, Issue 6, 2014, Pages 550-557

  Brown, Lee K ^a   Javaheri, Shahrokh ^b  

^a UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE   (United States)

Author keywords

Adaptive servo ventilation; Central sleep apnea; Congestive heart failure; Hunter Cheyne Stokes breathing

Indexed keywords

ADAPTIVE SERVO VENTILATION; ASSISTED VENTILATION; BREATHING PATTERN; CENTRAL SLEEP APNEA SYNDROME; CHEYNE STOKES BREATHING; CONGESTIVE HEART FAILURE; EVENT FREE SURVIVAL; HEART FUNCTION; HIGH RISK PATIENT; HUMAN; MORTALITY; NON INVASIVE PROCEDURE; POSITIVE END EXPIRATORY PRESSURE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SLEEP DISORDERED BREATHING; TREATMENT OUTCOME; CHEYNE-STOKES RESPIRATION; COMPLICATION; HEART FAILURE; OXYGEN THERAPY; PATHOPHYSIOLOGY; SLEEP APNEA, CENTRAL;

CHEYNE-STOKES RESPIRATION; CONTINUOUS POSITIVE AIRWAY PRESSURE; HEART FAILURE; HUMANS; OXYGEN INHALATION THERAPY; RANDOMIZED CONTROLLED TRIALS AS TOPIC; SLEEP APNEA, CENTRAL; TREATMENT OUTCOME;

EID: 84927797247     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/MCP.0000000000000108     Document Type: Review

References (31)

1. Javaheri S, Brown LK, Randerath WJ. Positive airway pressure therapy with adaptive servo-ventilation: part 1: operational algorithms. Chest 2014; 146:514-523. Detailed review of ASV technology for all three currently marketed devices incorporating the most recent information available on their operational algorithms.
2. Brown LK. Adaptive servo-ventilation for sleep apnea: technology, titration protocols, and treatment efficacy. Sleep Med Clin 2010; 5:419-437. Comprehensive review of the technology used in ASV devices from an engineering perspective, as well as description of titration strategies and earlier literature on clinical applications.
3. Berthon-Jones M, inventor; ResMed, Ltd, assignee. Ventilatory assistance for treatment of cardiac failure and Cheyne-Stokes breathing. US Patent 6532959 B1; 18 March 2003.
4. ResMed. Adaptive servo-ventilation. Available at: http://www.resmed.com/ us/clinicians/treatment/adapt-sv.html?nc=clinicians. [Accessed 6 April 2010]
5. Hill PD, inventor; Respironics, Inc, assignee. Method and apparatus for providing variable positive airway pressure. US Patent 6752151 B2; 22 June 2004.
6. Zdrojkowski RJ, Estes M, inventors; Respironics, Inc, assignee. Breathing gas delivery method and apparatus. US Patent 5803065 A. 8 September 1998.
7. Skatrud JB, Dempsey JA. Interaction of sleep state and chemical stimuli in sustaining rhythmic ventilation. J Appl Physiol Respir Environ Exerc Physiol 1983; 55:813-822.
8. Badr MS, Kawak A. Posthyperventilation hypopnea in humans during NREM sleep. Respir Physiol 1996; 103:137-145.
9. Meza S, Mendez M, Ostrowski M, Younes M. Susceptibility to periodic breathing with assisted ventilation during sleep in normal subjects. J Appl Physiol 1985; 85:1929-1940.
10. Javaheri S. A mechanism of central sleep apnea in patients with heart failure. N Engl J Med 1999; 341:949-954.
11. Nopmaneejumruslers C, Kaneko Y, Hajek V, et al. Cheyne-Stokes respiration in stroke: relationship to hypocapnia and occult cardiac dysfunction. Am J Respir Crit Care Med 2005; 171:1048-1052.
12. Teschler H, Dohring J, Wang YM, Berthon-Jones M. Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 2001; 164:614-619.
13. Randerath WJ, Galetke W, Kenter M, et al. Combined adaptive servoventilation and automatic positive airway pressure (anticyclic modulated ventilation) in co-existing obstructive and central sleep apnea syndrome and periodic breathing. Sleep Med 2009; 10:898-903.
14. Javaheri S, Brown LK, Randerath WJ. Positive airway pressure therapy with adaptive servo-ventilation: part 2: clinical applications of adaptive servoventilation devices. Chest 2014. [Epub ahead of print]
15. Aurora N, Chowdhuri S, Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep 2012; 35:17-40. The most recent review and practice parameters for treating CSA/HCSB from the American Academy of Sleep Medicine.
16. Yamada S, Sakakibara M, Yokota T, et al. Acute hemodynamic effects of adaptive servo-ventilation in patients with heart failure. Circ J 2013; 77: 1214-1220. The only published study examining the acute effects of ASV on cardiac hemodynamics in normal controls and patients with stable CHF. Hemodynamics were measured directly during cardiac catheterization. Normal patients experience a slight decrease in SVI, whereas patients separated into groups with increased SVI or decreased SVI. Baseline PCWP and mitral regurgitation/left atrial area were predictors of the change in SVI in patients.
17. Bellone A, Barbieri A, Ricci C, et al. Acute effects of noninvasive ventilatory support on functional mitral regurgitation in patients with exacerbation of congestive heart failure. Intensive Care Med 2002; 28:1348-1350.
18. Packer M, Coats AJ, Fowler MB, et al., Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001; 344:1651-1658.
19. Pepperell JC, Maskell NA, Jones DR, et al. A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure. Am J Respir Crit Care Med 2000; 168:1109-1114.
20. Ushijima R, Joho S, Akabane T, et al. Differing effects of adaptive servoventilation and continuous positive airway pressure on muscle sympathetic nerve activity in patients with heart failure. Circ J 2014; 78:1387-1395.
21. Fleischmann G, Fillafer G, Matterer H, et al. Prevalence of chronic kidney disease in patients with suspected sleep apnoea. Nephrol Dial Transplant 2010; 25:181-186.
22. Jhamb M, Unruh M. Bidirectional relationship of hypertension with obstructive sleep apnea. Curr Opin Pulm Med 2014; 20:558-564.
23. Yoshihisa A, Suzuki S, Owada T, et al. Short-term use of adaptive servo ventilation improves renal function in heart failure patients with sleep-disordered breathing. Heart Vessels 2013; 28:728-734. Study that demonstrated an acute improvement in renal function (cystatin C level and eGFR calculated using cystatin C) when CSA/HCSB was suppressed by ASV in patients with systolic heart failure.
24. Kourouklis SP, Vagiakis E, Paraskevaidis IA, et al. Effective sleep apnoea treatment improves cardiac function in patients with chronic heart failure. Int J Cardiol 2013; 168:157-162.
25. Koyama T, Watanabe H, Tamura Y, et al. Adaptive servo-ventilation therapy improves cardiac sympathetic nerve activity in patients with heart failure. Eur J Heart Fail 2013; 15:902-909.
26. Owada T, Yoshihisa A, Yamauchi H, et al. Adaptive servoventilation improves cardiorenal function and prognosis in heart failure patients with chronic kidney disease and sleep-disordered breathing. J Card Fail 2013; 19:225-232. Prospective observational study demonstrating an improvement in eGFR and event-free survival in patients with CKD, predominantly central SDB, and CHF who received 6 months of treatment with ASV. Patients who refused or were nonadherent to ASV did not experience these benefits.
27. Yoshihisa A, Suzuki S, Yamaki T, et al. Impact of adaptive servo-ventilation on cardiovascular function and prognosis in heart failure patients with preserved left ventricular ejection fraction and sleep-disordered breathing. Eur J Heart Fail 2013; 15:543-550. RCT in patients with diastolic dysfunction and CSA/HCSB randomized to either conventional pharmacotherapy or pharmacotherapy with ASV. After 6 months, the ASV group had improvement in diastolic dysfunction on echocardiography and event-free survival.
28. Bradley TD, Logan AG, Kimoff RJ, et al., CANPAP Investigators. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005; 353:2025-2033.
29. Kasai T, Kasagi S, Maeno K, et al. Adaptive servo-ventilation in cardiac function and neurohormonal status in patients with heart failure and central sleep apnea nonresponsive to continuous positive airway pressure. JACC Heart Fail 2013; 1:58-63. RCT comparing CPAP with ASV in patients with systolic heart failure and CSA/ HCSB. After 3 months, ASV patients had better adherence to device use, lower plasma BNP, mitral regurgitation area, and left ventricular end-systolic diameter as well as increased LVEF and better quality of life by SF-36
30. Hetland A, Haugaa KH, Olseng M, et al. Three-month treatment with adaptive servoventilation improves cardiac function and physical activity in patients with chronic heart failure and Cheyne-Stokes respiration: A prospective randomized controlled trial. Cardiology 2013; 126:81-90. RCT comparing standard pharmacotherapy to pharmacotherapy plus ASV in patients with systolic heart failure and CSA/HCSB. After 3 months of treatment, ASV patients had significant increases in LVEF, improved NYHA class, and longer 6MWD as well as a trend toward reduced CHF mortality.
31. Arzt M, Schroll S, Series F, et al. Auto-servoventilation in heart failure with sleep apnoea: a randomized controlled trial. Eur Respir J 2013; 42:1244-1254. RCT comparing standard pharmacotherapy with pharmacotherapy plus ASV in patients with systolic heart failure and SDB that was eitherOSA and/or CSA. LVEF increased slightly after 12 weeks in both groups by intention-to-treat and perprotocol analysis, whereas N-terminal pro-BNP remained significantly higher in the control group. Results also did not differ by predominant SDB mechanism (OSA versus CSA/HCSB).