The Complex Sleep Apnea Resolution Study: A Prospective Randomized Controlled Trial of Continuous Positive Airway Pressure Versus Adaptive Servoventilation Therapy

Abstract

Clinicaltrials.Gov NCT00915499.

Clinical Use of Loop Gain Measures to Determine Continuous Positive Airway Pressure Efficacy in Patients with Complex Sleep Apnea. A Pilot Study

“…Some authors have suggested that a poor initial experience with PAP therapy due to residual disease may lead to long-term nonadherence with PAP in some patients (19,20,23). Such a finding would theoretically support the concept of early intervention (perhaps with a newer ASV device) in such patients to avoid long-term nonadherence.…”

“…Such a finding would theoretically support the concept of early intervention (perhaps with a newer ASV device) in such patients to avoid long-term nonadherence. This concept is currently being studied (19), but our data do not support the use of ASV in an early intervention strategy for the purposes of improving adherence. Whether there are implications for sleep apnea symptoms and cardiovascular outcomes remains to be fully determined.…”

“…Known risk factors for persistent central events on CPAP included central events on the baseline sleep study, congestive heart failure/atrial fibrillation, and chronic opiate use (10,11). Randomized trials have shown that those with persistent central events show better control on adaptive servoventilation PAP devices (9,19,20). The downside of this adaptive-PAP therapy is that these devices are quite costly compared with CPAP, with which many patients do well.…”

Complex sleep apnea at auto‐titrating CPAP initiation: prevalence, significance and predictive factors

“…However, these findings make part of the ongoing debate about CompSA being solely treatment-emergent or transient CA, which could in many cases resolve spontaneously over time (10,21). In a very recent prospective randomized trial (CPAP vs adaptive servo-ventilation device (ASV)), Morgenthaler and colleagues (24) showed in an intention-to-treat analysis that, after 90 days of therapy, significantly more CompSA patients improved under ASV (89.7%) than under CPAP (64.5%). Whether pre-existing supposed chemo-reflex dysfunction can positively evolve in any patient is therefore questionable.…”

Emergent central sleep apnea during CPAP therapy-clinical implications

“…Nevertheless, it does raise the possibility that it might be responsible for CPAP discontinuation in some patients and therefore treatment might be helpful in patients with persistent or late emergence of CPAP emergent CSA. In this regard ASV is superior to other modalities for treatment of CPAP emergent CSA (11).…”