Combined adaptive servo-ventilation and automatic positive airway pressure (anticyclic modulated ventilation) in co-existing obstructive and central sleep apnea syndrome and periodic breathing

Abstract 

Background

The co-existence of obstructive and central sleep apnea/hypopnea syndrome (OSAS) and periodic breathing is common in patients with and without underlying heart diseases. While automatic continuous positive airway pressure (APAP) has proven to effectively treat OSAS, the adaptive servo-ventilation (ASV) sufficiently improves periodic breathing. This is the first trial on a device which combines both treatment modes.

Methods

Pilot study on a two-week treatment in patients with co-existing obstructive and central and periodic breathing disturbances during sleep. Twelve consecutive patients (9 male, 3 female, age 56.9±10.6 years, BMI 32.4±5.5kg/m²) were treated with a new algorithm which combines APAP and ASV (also called anticyclic modulated ventilation (ACMV), SOMNOventCR^®, Weinmann, Hamburg, Germany). Seven suffered from arterial hypertension, coronary heart disease and mitral regurgitation, none from congestive heart failure.

Results

The total apnea–hypopnea index (AHI) improved from 43.8±24.0/h to 2.1±2.4 (p<0.01), the obstructive AHI from 12.8±14.3/h to 0.3±0.6/h (p<0.01) and the central AHI from 31.0±17.5/h to 1.7±2.0/h (p<0.01). Moreover, there was a significant improvement in the total number of arousals, respiratory induced arousals, oxygen saturation and sleep profile.

Conclusion

The algorithm combining automatic continuous positive airway pressure (CPAP) and ASV normalizes all types of co-existing obstructive and central apnea/hypopnea and periodic breathing.

Keywords: Cheyne-Stokes respiration, Central sleep apnea, Obstructive sleep apnea, Complex sleep apnea, Periodic breathing, Adaptive servo-ventilation