Central Sleep Apnoea (CSA) treatment options

It can be challenging to treat patients with central SDB. Continuous positive airway pressure or automatic positive airway pressure (CPAP/APAP) therapy is often used as the treatment of first intention, but experience shows that CPAP/APAP does not consistently control apnoeas or improve symptoms. As a result, some patients treated with CPAP/APAP remain symptomatic and this increases the risk of noncompliance and the likelihood that they will require multiple, resource-intensive interventions.

ASV (adaptive servo-ventilation)* is always an appropriate choice for treating most of these more complex patients, either as a first intention therapy or after an unsuccessful trial with other PAP therapies.

 

Adaptive servo-ventilation: a proven solution for CSA

ASV is a form of positive airway pressure (PAP) therapy that delivers auto-adjusting pressure support (with automatic Pressure Support (PS) and Expiratory Positive Airway Pressure (EPAP). ASV helps to treat both obstructive and central respiratory events and maintains adequate ventilation in response to patients’ changing needs.

Therapy Aim Features Pressure Profile
Continuous Positive Airway Pressure (CPAP) Maintain open upper airways Fixed pressure
Automatic Positive Airway Pressure (APAP) Maintain open upper airways Continually adjusting pressure to optimize pressure level to the patient’s needs
Variable Positive Airway Pressure (VPAP) Support breathing in lung disease-related respiratory insufficiency Fixed expiratory pressure and pressure support at inspiration, usually with fixed back-up rate
Adaptive Servo-Ventilation (ASV Stabilise breathing and keep upper airway open Continually adjusting inspiratory and expiratory pressure with variable, on-demand, back up rate

Compared to other forms of PAP therapy, ASV offers significant benefits for the treatment of central SDB*. This has been demonstrated in multiple clinical trials across various patient types.

 

Who is ASV* therapy suitable for?

Any patient with left ventricular ejection fraction (LVEF)>45% is eligible for ASV. 1,2,3,4 We can confirm that the observed mortality risk in SERVE-HF occurs in patients with LVEF ≤45% and that the harmful effects of ASV correlate with pre-existing LV systolic impairment.5

• Reduced LVEF should be excluded before starting ASV1. Before using ASV, it is important to ensure that LVEF is >45%. Echocardiography is recommended for this purpose.

• Experts’ statements1,2,3,4 and healthcare authorities agree that patients with LVEF>45% remain eligible for ASV when there is a clinical rationale for using it. ASV is eligible in these different situations1,2,3,4 :

  - Heart failure with preserved ejection fraction

  - CSA associated with long-term opioid therapy without alveolar hypoventilation

  - Idiopathic CSA or Cheyne-Stokes Respiration

  - Complex/Emergent/Resistant CSA

  - CSA after ischemic stroke.

• Since May 2015, the French and German healthcare authorities have agreed to limit the contra-indication to heart failure with reduced EF ≤45%.5

Find out more about the ResMed device that uses ASV therapy: AirCurveTM 10 CS PaceWaveTM

References

* ASV therapy is contraindicated in patients with chronic, symptomatic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnoea.

  • 01

    d’Ortho et al. European Respiratory & Pulmonary Diseases, 2016;2(1):Epub ahead of print. http://doi.org/10.17925/ERPD.2016.02.01.1

  • 02

    Priou P & al. Adaptive servo-ventilation: How does it fit into the treatment of central sleep apnoea syndrome? Expert opinions. Revue des Maladies Respiratoires, 2015 Dec, 32(10):1072-81

  • 03

    Aurora RN & al. Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses". Journal of Clinical Sleep Medicine, 2016 May 15, 12(5):757-61

  • 04

    Randerath W et al. ERJ Express. Published on December 5, 2016 as doi: 10.1183/13993003.00959-2016

  • 05

    AirCurve 10 CS PaceWave clinical manual July 2015