Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!

Abstract

Backgrounds To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p < 0.001). MV differences between ASV-F (p = 0.002) and ASV-V (p < 0.001) were not homogenously distributed across clusters, suggesting specific cluster and ASV-algorithm interactions. Individual ASV-data suggest that the hyperventilation risk is not related to the cluster nor the ASV-monitoring type. Conclusions Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.

Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation (READ-ASV): protocol and cohort profile

“…This is consistent with data from a German study, which reported that TE-CSA was the indication for ASV therapy in 67% of the 264 patients studied [49]. In contrast, 20% of patients enrolled in a prospective study of ASV in clinical practice had TE-CSA, whereas most ASV users (60%) had pre-existing CSA [48]. The official definition of TE-CSA states that cardiovascular disease should be ruled out as a cause for TE-CSA [30].…”

“…This difference compared with current guidelines is a limitation of the registry. However, most patients with TE-CSA also have cardiovascular comorbidities, as also documented in other registries [48][49][50]. Furthermore, the prevalence of TE-CSA or persisting CSA in patients with normal levels of B-type natriuretic peptide (BNP) has been shown to be low [51], while TE-CSA is common in patients with OSA and heart failure initially treated with CPAP [50].…”

“…READ-ASV is the largest prospective registry or study to date investigating the usage and effects of ASV in a real-world cohort with SDB. One real-world registry with 214 enrolled patients has reported data on the clinical characteristics of patients receiving ASV in clinical practice [48].…”

Ist die ASV-Therapie eine Überdruck- oder eine Beatmungstherapie? Ein Vergleich des SBH am Tag und unter ASV

“…Dieses Ergebnis fand sich auch in einer anderen Studie [18] . Diese hat von 177 Patienten mit Cheyne-Stokes-Atmung, die mit 2 verschiedenen ASV-Geräten behandelt wurden, viele Daten u. a. die Atemminutenvolumina aus den Geräten erfasst.…”