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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Jul 28, 2015; 5(2): 112-125
Published online Jul 28, 2015. doi: 10.5320/wjr.v5.i2.112
Effectiveness of adaptive servo-ventilation
Yasuhiro Tomita, Takatoshi Kasai
Yasuhiro Tomita, Cardiovascular Center, Toranomon Hospital, Minato-ku, Tokyo 105-8470, Japan
Yasuhiro Tomita, Takatoshi Kasai, Sleep Center, Toranomon Hospital, Minato-ku, Tokyo 105-8470, Japan
Yasuhiro Tomita, Takatoshi Kasai, Cardio-Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
Takatoshi Kasai, Department of Cardiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
Author contributions: Tomita Y and Kasai T drafted the article; Kasai T revised it critically.
Supported by Partly supported by a Grant-in-Aid for Scientific Research (C), No. 26507010; and a grant to the Respiratory Failure Research Group from Ministry of Health, Labor and Welfare, Japan.
Conflict-of-interest statement: Yasuhiro Tomita and Takatoshi Kasai belong to endowed department (Cardio-Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine) by Philips-Respironics, Teijin Pharma and Fukuda Denshi.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takatoshi Kasai, MD, PhD, Cardio-Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan. kasai-t@mx6.nisiq.net
Telephone: +81-3-38133111 Fax: +81-3-56890627
Received: January 24, 2015
Peer-review started: January 25, 2015
First decision: March 6, 2015
Revised: April 16, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: July 28, 2015
Processing time: 192 Days and 3.5 Hours
Abstract

Adaptive servo-ventilation (ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea (CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea (OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure (CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatment-emergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.

Keywords: Adaptive servo-ventilation; Central sleep apnea; Cheyne-Stokes respiration; Continuous positive airway pressure; Heart failure; Positive airway pressure; Sleep disordered breathing

Core tip: Adaptive servo-ventilation (ASV) is a form of positive airway pressure device that is used to treat Cheyne-Stokes respiration and central sleep apnea with various etiologies. Accumulating evidence supports the use of ASV in patients with heart failure. However, some existing data suggest that ASV should be used in other situations. In this review, we highlight the clinical applications and effectiveness of ASV and describe future perspectives regarding its applications.