Adaptive servo-ventilation in patients with chronic heart failure and sleep disordered breathing: predictors of usage
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EPIDEMIOLOGY • ORIGINAL ARTICLE
Adaptive servo-ventilation in patients with chronic heart failure and sleep disordered breathing: predictors of usage Leonie Kolb 1 & Michael Arzt 1 & Stefan Stadler 1 & Katharina Heider 1 & Lars S. Maier 1 & Maximilian Malfertheiner 1 Received: 26 March 2020 / Revised: 10 July 2020 / Accepted: 21 August 2020 # The Author(s) 2020
Abstract Purpose Adaptive servo-ventilation (ASV) is a therapy designed for patients with central sleep apnea (CSA) and Cheyne Stokes respiration. The aim of this study was to find predictors of ASV usage in patients with CSA in a routine sleep clinic cohort. Methods In this retrospective study, consecutive patients in whom ASV therapy was initiated at the University Hospital Regensburg between 2011 and 2015, were analyzed. Analysis included polysomnographies of diagnostic and ASV initiation nights, a phone questionnaire on ASV usage, readout of the ASV device 1 month after initiation (“early ASV usage,” 1 month after ASV initiation), and the readout of the last month before a reappointment date set in 2015 (“late ASV usage,” median 17 months after ASV initiation). Results In 69 consecutive patients, the mean early and late ASV usage per night was 4.8 ± 2.5 h and 4.1 ± 3.0 h, respectively. Seventeen months after initiation, 57% of patients used the device ≥ 4 h per night, and of those 91% reported a subjective benefit from ASV therapy. Early ASV usage was significantly associated with late ASV usage (univariable regression: Beta 0.8, 95%CI [0.6; 1.0] p < 0.001). In multivariable regression analysis, short duration of slow wave sleep (N3) during diagnostic polysomnography (Beta − 6.2, 95%CI [− 11.0; − 1.5]; p = 0.011) and subjective benefit from ASV (Beta 174.0, 95%CI [68.6; 279.5]; p = 0.002) were significantly associated with longer late ASV usage. Conclusion Early ASV usage predicts late ASV usage. In addition, low slow wave sleep before ASV initiation and subjective benefit from ASV may contribute to higher late ASV usage. Keywords Central sleep apnea . Adaptive servo-ventilation . Usage . Adherence . Cheyne Stokes respiration . Sleep stages
Introduction Positive airway pressure therapies such as continuous positive airway pressure (CPAP) and adaptive servo-ventilation (ASV) are important treatments of various forms of sleep disordered breathing (SDB). ASV was designed for patients with central sleep apnea (CSA) and Cheyne Stokes respiration (CSR) [1–3] and is also effective in patients with other types of CSA [4–6]. Since the results of the SERVE-HF trial Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11325-020-02182-2) contains supplementary material, which is available to authorized users. * Michael Arzt [email protected] 1
Department of Internal Medicine II, Cardiology and Pneumology, Center for Sleep Medicine, University Medical Center Regensburg, Regensburg, Germany
became public in 2015, showing an increased risk for cardiovascular mortality in the ASV-treated group of patients with chronic hea
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