Home-use servo-ventilation therapy in chronic pain patients with central sleep apnea: initial and 3-month follow-up

Shapiro, Colin M.; Chung, Sharon A.; Wylie, Paul E.; Hossain, Naheed K.; Holle, Rolf H.O.; Rosenberg, Russell; Muehlbach, Mark J.; Doekel, Robert C.; Pegram, G. Vernon; Jasko, Jeff

doi:10.1007/s11325-015-1161-7

Cited by 31 publications

(15 citation statements)

References 38 publications

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“…If SDB is suspected or confirmed and the patient is being prescribed COT, one should consider a number of risk mitigation interventions including: Opioid dose reduction Trial of nonopioid therapies (NSAIDs, antiepileptic drugs, physical therapy, antidepressants, etc.) in lieu of opioids Avoiding use of benzodiazepines, sedatives, and hypnotics Caution against alcohol use Sleep medicine consultation and treatment of SDB (for example there is evidence of the efficacy of adaptive cervo‐ventilation and bilevel positive airway pressure ventilation for CSA in patients on COT ) …”

Section: Risk Assessment and Mitigation Strategiesmentioning

confidence: 99%

Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies

Cheatle

Webster

2015

Pain Med

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Objective Patients with chronic pain frequently experience concomitant sleep disorders. There has been controversy on whether opioids have a beneficial or deleterious effect on sleep quality, duration and efficiency. There is also concern regarding the association between chronic opioid therapy and sleep disordered breathing and the increased risk for unintentional opioid related overdose. This article provides a narrative review of the literature on the effect of opioids on sleep disorders and discusses risk assessment and mitigation strategies. Design A narrative review of the current literature on the effect of prescription opioids on sleep quality and efficiency, the relationship between opioids and sleep disorders and potential risk factors in patients with chronic pain. Results There is conflicting evidence regarding the benefit of opioids in improving sleep quality, duration and efficiency with several studies and reviews suggesting a beneficial effect of opioids on sleep and other studies demonstrating the opioids can cause sleep disturbance leading to hyperalgesia. There was credible evidence of a strong relationship between opioids and sleep disordered breathing with noted risk factors including use of methadone, high opioid dosing (> 200 mg MED) and combining opioids with benzodiazepines. Conclusions Further research is required to elucidate the effect of prescription opioids on sleep quality and pain intensity and the risks associated with opioids and sleep disordered breathing. The risk of sleep disordered breathing should be routinely assessed in patients on chronic opioid therapy.

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Section: Risk Assessment and Mitigation Strategiesmentioning

confidence: 99%

Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies

Cheatle

Webster

2015

Pain Med

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“…Prevalence of SDB is known to be high in these patients and is often symptomatic (40,41). Although a few clinical studies have shown that ASV could control SDB (CSA) in patients under chronic high dose opioid treatment (18,19,42), there are no randomized trials showing a long term improvement in either symptom scales, HRQL or survival. Many questions therefore remain, such as: should we screen patients under opioids for SDB?…”

Section: Discussionmentioning

confidence: 99%

“…The recent SERVE-HF study questioned the use of ASV in cardiac failure: in patients with chronic heart failure (CHF) and a left ventricular ejection fraction (LVEF) ≤45%, ASV was associated with an increase in mortality (9). Although designed for CSB, use of ASV has drifted in clinical practice to other indications such as emerging sleep apnea (10)(11)(12)(13)(14)(15)(16), central or mixed apnea syndromes (17), either idiopathic, drug-induced (18)(19)(20)(21)(22)(23), or associated with neurologic disorders (10)(11)(12)24). Use of ASV in these indications does not rely on a high level of evidence of efficacy or benefit on outcomes such as survival or health-related quality of life.…”

Section: Introductionmentioning

confidence: 99%

Adaptive Servo-Ventilation: A Comprehensive Descriptive Study in the Geneva Lake Area

Cantero¹,

Adler

Pasquina

et al. 2020

Front. Med.

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Background: Use of adaptive servo-ventilation (ASV) has been questioned in patients with central sleep apnea (CSA) and chronic heart failure (CHF). This study aims to detail the present use of ASV in clinical practice. Methods: Descriptive, cross-sectional, multicentric study of patients undergoing long term (≥3 months) ASV in the Cantons of Geneva or Vaud (1,288,378 inhabitants) followed by public or private hospitals, private practitioners and/or home care providers. Results: Patients included (458) were mostly male (392; 85.6%), overweight [BMI (median, IQR): 29 kg/m 2 (26; 33)], comorbid, with a median age of 71 years (59-77); 84% had been treated by CPAP before starting ASV. Indications for ASV were: emergent sleep apnea (ESA; 337; 73.6%), central sleep apnea (CSA; 108; 23.6%), obstructive sleep apnea (7; 1.5%), and overlap syndrome (6; 1.3%). Origin of CSA was cardiac (n = 30), neurological (n = 26), idiopathic (n = 28), or drug-related (n = 22). Among CSA cases, 60 (56%) patients had an echocardiography within the preceding 12 months; median left ventricular ejection fraction (LVEF) was 62.5% (54-65); 11 (18%) had a LVEF ≤45%. Average daily use of ASV was [mean (SD)] 368 (140) min; 13% used their device <3:30 h. Based on ventilator software, apnea-hypopnea index was normalized in 94% of subjects with data available (94% of 428). Conclusions: Use of ASV has evolved from its original indication (CSA in CHF) to a heterogeneous predominantly male, aged, comorbid, and overweight population with mainly ESA or CSA. CSA in CHF represented only 6.5% of this population. Compliance and correction of respiratory events were satisfactory.

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“…In contrast, most studies have shown that ASV is more effective than other therapies, including CPAP and BPAP, in reducing central events, although this finding is not universal . Long‐term use of ASV has been reported in two studies, confirming sustained control of SDB and good adherence to therapy . However, there is a lack of data concerning the impact of PAP including ASV on clinical outcomes such as quality of life or mortality.…”

Section: Adaptive Servoventilationmentioning

confidence: 98%

“…23,26 Long-term use of ASV has been reported in two studies, confirming sustained control of SDB and good adherence to therapy. 24,27 However, there is a lack of data concerning the impact of PAP including ASV on clinical outcomes such as quality of life or mortality.…”

Section: Opioid-induced Central Apnoeamentioning

confidence: 99%

Advances in non‐invasive positive airway pressure technology

Piper

2019

Respirology

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Non‐invasive ventilation (NIV) has become the standard of care for patients with a range of respiratory and sleep breathing disorders. Technological advances have enabled the development of several newer modes of automatically adapting NIV suitable for patients with more complex breathing abnormalities that may be difficult to manage effectively with more traditional positive airway pressure therapy. These modes allow for more stable ventilation when fluctuating ventilation requirements occur such as in positional upper airway obstruction or state‐related variations in respiratory mechanics and drive. Adaptive servoventilation (ASV) is designed for patients with periodic breathing and central apnoeas in whom carbon dioxide levels are normal to low, with the goal of therapy to dampen and stabilize ventilation. In contrast, volume‐assured pressure support is used in diagnostic groups characterized by hypoventilation, where targeting an effective level of ventilation irrespective of sleep stage or body position is required. These newer modes have the potential to simplify and optimize ventilation, although at present there is no evidence that they are clinically superior to standard home ventilation techniques. The complexity and differences in algorithms and features of various device brands, along with a limited evidence base documenting longer term outcomes, complicate decisions around which patient phenotypes are best suited to these newer modes. In‐built sensor and data storage capabilities of newer home ventilation devices provide the opportunity for earlier recognition of issues with ventilation and to guide corrective action. Further work is needed to determine how this impacts longer term clinical outcomes.

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Home-use servo-ventilation therapy in chronic pain patients with central sleep apnea: initial and 3-month follow-up

Cited by 31 publications

References 38 publications

Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies

Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies

Adaptive Servo-Ventilation: A Comprehensive Descriptive Study in the Geneva Lake Area

Advances in non‐invasive positive airway pressure technology

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