DOES ADAPTIVE SERVO VENTILATION HELP RESOLVE CENTRAL SLEEP APNEA

Obstructive sleep apnea (OSA) occurs more frequently in patients with congestive heart failure (CHF) than in the general population. Central sleep apnea (CSA) and Cheyne-Stokes respiration is seen in 25-40% of patients who have CHF with a reduced left ventricular ejection fraction (LVEF). Adaptive servo-ventilation (ASV) alleviates central and obstructive sleep apnea by delivering servo-controlled inspiratory pressure support on top of expiratory positive airway pressure. We hypothesize that ASV over time has a beneficial effect on cardiovascular function, leading to resolution of CSA off positive airway pressure (PAP) therapy. We evaluated all subjects > 18 years using ASV at home who had attended polysomnography (PSG) between 01/2009 and 12/2018. We excluded patients who were not using ASV at the time of the study and those who were on opiates when they had their initial PSG. We attempted to identify the proportion of patients who had resolution of their central sleep apnea off ASV on the repeat PSG. There were 8 patients who met our study criteria (75% male, age 51-90 years). 4/8 patients (50%) had primary complex sleep apnea (CompSA) while the remainder had secondary CompSA/PAP-emergent CSA. The length of time utilizing ASV was 4.52 +/- 2.03 years (range 1.19-6.76 years). The CSA resolved in 7/8 patients (87.5%) on follow-up polysomnography off ASV. All subjects had residual OSA. The only patient who had non-resolution of his central sleep apnea had interval development of a non-ischemic cardiomyopathy and critical aortic stenosis with a significant decline in his LVEF. The patients who had resolution of CSA with ASV had a mean 3% improvement in LVEF. Treatment with ASV for 4.52 +/- 2.03 years years led to resolution of CSA in most patients with CompSA on follow-up PSG, but all had residual OSA. This may be due to improvement in cardiac function and circulation time. Support (If Any)