Adaptive servo-ventilation in patients with coexisting obstructive sleep apnoea/hypopnoea and Cheyne–Stokes respiration☆

Abstract 

Objective

The coexistence of obstructive (OSAS) and central sleep apnoea (CSA) and Cheyne–Stokes respiration (CSR) is common in patients with and without underlying heart diseases. CPAP has been shown to improve CSA/CSR by about 50%, but recent data suggest maximal suppression of CSA is important in improving clinical outcomes in heart failure patients. Adaptive servo-ventilation (ASV) effectively suppresses CSA/CSR in heart failure, but only few trials have considered patients with coexisting OSAS and CSA/CSR.

Methods

Prospective, observational pilot study to evaluate the efficacy of a new ASV device, the BiPAP AutoSV, in 10 male consecutive patients with coexisting OSAS and CSA/CSR with and without heart failure over eight weeks. Six had stable heart failure.

Measurements and Results

The total AHI improved from 48.9±20.6/h to 8.7±7.4, the obstructive AHI from 15.8±16.2/h to 2.6±2.5/h and the central AHI from 33.1±10.8/h to 6.1±5.9/h (all p<0.01). Furthermore, there was a significant improvement in sleep profile and respiratory related arousals. The six patients with cardiovascular disease, including three with congestive heart failure, showed similar improvements in all parameters.

Conclusions

BiPAP AutoSV was effective in reducing all types of respiratory disturbances in coexisting OSAS and CSA/CSR with and without heart failure. Further studies comparing the long-term clinical efficacy of this device against CPAP are warranted.

Abbreviations: AHI central, number of central apnoeas/hypopoeas and CSR per hour of TST, AHI obstructive, number of obstructive apnoeas/hypopoeas per hour of TST, AHI total, total number of apnoeas/hypopoeas per hour of TST, AHI, apnoea hypopnoea index, Arousal resp., number of respiration-related arousals per hour of TST, Arousal total, total number of arousals per hour of TST, ASDA, American Sleep Disorders Association, ASV, adaptive servo-ventilation, CPAP, continuous positive airway pressure, CSA, central sleep apnoea, CSR, Cheyne–Stokes respiration, EPAP, expiratory positive airways pressure, IPAP (min/max), (minimal/maximal) inspiratory positive airway pressure, OSAS, obstructive sleep apnoea syndrome, REM (%), stage “rapid eye movement” as proportion of TST, REM (min), time spent in stage “rapid eye movement”, S1, S2, S3, S4 (min), time spent in sleep stages 1, 2, 3, 4, S1/S2 (%), stages S1 and 2 as proportion of TST, S3/S4 (%), stages S1 and 2 as proportion of TST, SaO₂ <90%, time spent at an oxygen saturation <90%, SaO₂ mean, mean oxygen saturation, SaO₂ min, minimal oxygen saturation, TST, total sleep time (min), WASO, time of wakefulness after sleep onset

Keywords: Cheyne–Stokes respiration, Central sleep apnoea, Obstructive sleep apnoea, Complex sleep apnoea, Adaptive servo-ventilation, CPAP, Arterial hypertension, Heart failure