Abstract
Purpose
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 (AutoSet™CS).
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.
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References
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235
Javaheri S, Parker TJ (1998) Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 97:2154–2159
Khayat RN, Jarjoura D, Patt B, Yamokoski T, Abraham WT (2009) In-hospital testing for sleep-disordered breathing in hospitalized patients with decompensated heart failure: Report of prevalence and patient characteristics. J Card Fail 15:739–746
Oldenburg O, Lamp B, Faber L, Teschler H, Horstkotte D, Töpfer V (2007) Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail 9:251–257
Schulz R, Blau A, Börgel J, Duchna HW, Fietze I, Koper I, Prenzel R, Schädlich S, Schmitt J, Tasci S, Andreas S, working group Kreislauf und Schlaf of the German Sleep Society (DGSM) (2007) Sleep apnoea in heart failure. Eur Respir J 29:1201–1205
Vazir A, Hastings PC, Dayer M, McIntyre HF, Henein MY, Poole-Wilson PA, Cowie MR, Morrell MJ, Simonds AK (2007) A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail 9:243–250
Kahwash R, Kikta D, Khayat R (2011) Recognition and management of sleep-disordered breathing in chronic heart failure. Curr Heart Fail Rep 8:72–79
Javaheri S, Caref EB, Chen E, Tong KB, Abraham WT (2010) Sleep apnea testing and outcomes in a large cohort of medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med 183:539–546
Lee CH, Khoo SM, Chan MY, Wong HB, Low AF, Phua QH, Richards AM, Tan HC, Yeo TC (2011) Severe obstructive sleep apnea and outcomes following myocardial infarction. J Clin Sleep Med 7:616–621
Khayat R, Abraham W, Patt B, Brinkman V, Wannemacher J, Porter K, Jarjoura D (2012) Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. J Card Fail 18:534–540
Jilek C, Krenn M, Sebah D, Obermeier R, Braune A, Kehl V, Schroll S, Montalvan S, Riegger GA, Pfeifer M, Arzt M (2011) Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail 13:68–75
Karavidas A, Kapsimalis F, Lazaros G, Markozanes E, Arapi S, Cholidou K, Matzaraki V, Kyrkou K, Tsiachris D, Matsakas E, Pyrgakis V, Alchanatis M (2011) The impact of positive airway pressure on cardiac status and clinical outcomes in patients with advanced heart failure and sleep-disordered breathing: a preliminary report. Sleep Breath 15:701–709
Yoshihisa A, Suzuki S, Miyata M, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y (2012) A single night’ beneficial effects of adaptive servo-ventilation on cardiac overload, sympathetic nervous activity, and myocardial damage in patients with chronic heart failure and sleep-disordered breathing. Circ J 76:2153–2158
Koyama T, Watanabe H, Igarashi G, Terada S, Makabe S, Ito H (2011) Short-term prognosis of adaptive servo-ventilation therapy in patients with heart failure. Circ J 75:710–712
Oldenburg O, Schmidt A, Lamp B, Bitter T, Muntean BG, Langer C, Horstkotte D (2008) Adaptive servoventilation improves cardiac function in patients with chronic heart failure and Cheyne-Stokes respiration. Eur J Heart Fail 10:581–586
Teschler H, Döhring J, Wang YM, Berthon-Jones M (2001) Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 164:614–619
Oldenburg O, Bitter T, Lehmann R, Korte S, Dimitriadis Z, Faber L, Schmidt A, Westerheide N, Horstkotte D (2011) Adaptive servoventilation improves cardiac function and respiratory stability. Clin Res Cardiol 100:107–115
Oldenburg O, Bartsch S, Bitter T, Schmalgemeier H, Fischbach T, Westerheide N, Horstkotte D (2012) Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing. Sleep Breath 16:753–757
Hastings PC, Vazir A, Meadows GE, Dayer M, Poole-Wilson PA, McIntyre HF, Morrell MJ, Cowie MR, Simonds AK (2010) Adaptive servo-ventilation in heart failure patients with sleep apnea: a real world study. Int J Cardiol 139:17–24
Koyama T, Watanabe H, Kobukai Y, Makabe S, Munehisa Y, Iino K, Kosaka T, Ito H (2010) Beneficial effects of adaptive servo ventilation in patients with chronic heart failure. Circ J 74:2118–2124
Randerath WJ, Nothofer G, Priegnitz C, Anduleit N, Treml M, Kehl V, Galetke W (2012) Long-term auto-servoventilation or constant positive pressure in heart failure and coexisting central with obstructive sleep apnea. Chest 142:440–447
Pepperell JC, Maskell NA, Jones DR, Langford-Wiley BA, Crosthwaite N, Stradling JR, Davies RJ (2003) A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure. Am J Respir Crit Care Med 168:1109–1114
Philippe C, Stoïca-Herman M, Drouot X, Raffestin B, Escourrou P, Hittinger L, Michel PL, Rouault S, d’Ortho MP (2006) Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a 6 month period. Heart 92:337–342
Haruki N, Takeuchi M, Kaku K, Yoshitani H, Kuwaki H, Tamura M, Abe H, Okazaki M, Tsutsumi A, Otsuji Y (2011) Comparison of acute and chronic impact of adaptive servo-ventilation on left chamber geometry and function in patients with chronic heart failure. Eur J Heart Fail 13:1140–1146
Iber C, Ancoli-Israel S, Chesson A, Quan SF, eds (2007) American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification, 1st ed. American Academy of Sleep Medicine, Westchester, Illinois
Monomura S-I (2013) Treatment of Cheyne-Stokes respiration-central sleep apnea in patients with heart failure. J Cardiol 59:110–116
Yoshihisa A, Shimizu T, Owada T, Nakamura Y, Iwaya S, Yamauchi H, Miyata M, Hoshino Y, Sato T, Suzuki S, Sugimoto K, Yamaki T, Kunii H, Nakazato K, Suzuki H, S-i S, Takeishi Y (2011) Adaptive servo ventilation improves cardiac dysfunction and prognosis in chronic heart failure patients with Cheyne-Stokes respiration. Int Heart J 52:218–223
Bitter T, Westerheide N, Hossain MS, Lehmann R, Prinz C, Kleemeyer A, Horstkotte D, Oldenburg O (2011) Complex sleep apnoea in congestive heart failure. Thorax 66:402–407
Oldenburg O (2012) Cheyne-Stokes respiration in chronic heart failure. Circ J 76:2305–2317
Yoshida M, Kadokami T, Momii H, Hayashi A, Urashi T, Narita S, Kawamura N, Ando S-I (2012) Enhancement of cardiac performance by bilevel positive airway pressure ventilation in heart failure. J Card Fail 18:912–918
Cowie MR, Woehrle H, Wegscheider K, Angermann C, d’Ortho M-P, Erdmann E, Levy P, Simonds A, Somers VK, Zannad F, Teschler H (2013) Rationale and design of the SERVE-HF study: adaptive servo-ventilation treatment of sleep-disordered breathing with predominant central sleep apnoea in patients with chronic heart failure. Eur J Heart Fail 15:937–943
Acknowledgments
Medical writing assistance was provided by Nicola Ryan, independent medical writer, on behalf of ResMed. Furthermore, we thank the ResMed Science Center, in particular Dr. Holger Woehrle and Dr. Adam Benjafield, for their support in preparing, conducting and interpretation of the study.
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Oldenburg, O., Spießhöfer, J., Fox, H. et al. Performance of conventional and enhanced adaptive servoventilation (ASV) in heart failure patients with central sleep apnea who have adapted to conventional ASV. Sleep Breath 19, 795–800 (2015). https://doi.org/10.1007/s11325-014-1083-9
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DOI: https://doi.org/10.1007/s11325-014-1083-9