Use of average volume-assured pressure support as a therapeutic option in patients with central sleep apnea syndrome

Levri, John Mario; Watanabe, Naomitsu; Peng, V; Scharf, Steven M.; Diaz‐Abad, Montserrat

doi:10.1007/s11325-021-02379-z

Cited by 1 publication

(2 citation statements)

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“…Continuous positive airway pressure (CPAP) therapy is recommended for the management of residual OSA following adenotonsillectomy [ 2 , 12 ]. However, CPAP titration may fail due to multiple reasons, including persistent OSA despite CPAP, persistent hypoventilation despite CPAP, treatment-emergent central sleep apnea, and patient intolerance to CPAP therapy [ 13 - 17 ]. Bilevel PAP may be used when CPAP fails or is not tolerated [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Average volume-assured pressure support (AVAPS) is an automatically titrating mode of noninvasive ventilation, which provides a target tidal volume by adjustment of inspiratory positive airway pressure (IPAP) within a set range [ 13 - 15 ]. More recently, AVAPS has been used as a noninvasive ventilation strategy for the treatment of hypoventilation disorders such as chronic obstructive pulmonary disease, obesity, hypoventilation syndrome, and chronic respiratory failure [ 13 , 18 ]. A study of 45 adults with OSA, who had failed CPAP titration, found AVAPS to be effective in reducing the apnea-hypopnea index (AHI, events/hour) and improving sleep architecture [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Average Volume-assured Pressure Support as Rescue Therapy after CPAP Failure in Pediatric Obstructive Sleep Apnea: A Retrospective Case Series Study

Peng¹,

Hwig²,

Lasso‐Pirot³

et al. 2023

TORMJ

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Background: Continuous positive airway pressure (CPAP) is frequently prescribed for patients with residual obstructive sleep apnea (OSA) following adenotonsillectomy. Objectives: The goal was to examine the efficacy of noninvasive ventilation with average volume-assured pressure support (AVAPS) as a potential option for children with failed CPAP titration. Methods: In a single-center retrospective study, we included children aged 1-17 years, with polysomnographically confirmed OSA who underwent AVAPS titration following failed CPAP titration. In addition to describing the clinical characteristics of the included patients, we compared polysomnographic parameters before and after AVAPS. Results: Nine patients met the inclusion criteria; out of them, 8 (89%) were males with an age range of 6.7 ± 3.9 years and a body mass index percentile of 81.0 ± 28.9. Reasons for failed CPAP titration were: 3 (33%) patients due to inability to control apnea-hypopnea index (AHI), 3 (33%) patients due to sleep-related hypoventilation, 2 (22%) patients due to treatment-emergent central sleep apnea, and 1 (11%) patient due to intolerance to CPAP. AVAPS resulted in a greater reduction in AHI than CPAP (reduction following CPAP = 24.6 ± 29.3, reduction following AVAPS = 42.5 ± 37.6, p = 0.008). All patients had resolution of the problems which caused CPAP failure. Conclusion: In this case a series of children with OSA and with failed CPAP titration, AVAPS resulted in a greater reduction in AHI compared with CPAP as well as resolution of the problems which caused CPAP failure.

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