Effectiveness of adaptive servo-ventilation

Table 1 An overview of the futures of the three adaptive servo-ventilation devices

Manufacturer	ResMed	Philips-Respironics	Weinmann
Current version	S9 VPAP Adapt, AutoSet CS-A	BiPAP autoSV Advanced System One	Prisma LINE CR
EPAP (default)	4-15 cmH2O auto	4-15 cmH2O auto	4-20 cmH2O auto
(min EPAP)	4-15 cmH2O	4-25 cmH2O	4-20 cmH2O
(max EPAP)	min EPAP-15 cmH2O	min EPAP-25 cmH2O	min EPAP-20 cmH2O
IPAP	Max 30 cmH2O	Max 25 cmH2O	Max 30 cmH2O
PS	0 to 30-prevailing EPAP	0 to 25-prevailing EPAP	0 to 30-prevailing EPAP
Calculation	The recent 3-min average minute volume	The recent 4-min average peak flow	The average of the minute volume in the recent 2-min and an earlier interval
Target for PS	90% of the average minute volume	90%-95% of the average peak flow (without SDB)	Relative minute volume of the current breath to the average
		60% percentile of peak flow (with SDB)
	Approximate the minute volume to the target	Approximate the peak inspiratory flow to the target	Stabilize the relative minute volume
Backup rate	Auto (cannot be established manually)	Auto (default) or fixed rate	Auto (default) or fixed rate

EPAP: Expiratory positive airway pressure; IPAP: Inspiratory positive airway pressure; PS: Pressure support; SDB: Sleep disordered breathing.

Table 2 Clinical trials assessing the effects of adaptive-servo ventilation on cardiac function in heart failure patients with central sleep apnea

Ref.	Study design	n	Duration (mo)	Baseline		Device usage (h)	Changes
				AHI	EF		AHI	EF
Pepperell et al[36]	RCT
	Subtherapeutic	15	1	17.7	35.7	3.9	-3	0.5
	Therapeutic	15		21.9	36.5	5.0	-16.5	1.8
Philippe et al[3]	RCT
	CPAP	13	6	40.5	30.0	4.2	-20	-2
	ASV	12		47.0	29.0	5.8	-45	7
Fietze et al[37]	RCT
	Bi-level PAP	15	1.5	34.9	25.5	4.81	-18.5	5.6
	ASV	15		31.7	24.6		-20.5	1.9
1Kasai et al[4]	RCT
	CPAP-mode	11	3	23.02	33.0	3.3	0.1	-1
	ASV-mode	12		25.02	32.0	4.7	-23	5.8

¹Patients with residual AHIs ≥ 15 on CPAP were included;

²AHIs on CPAP were described. AHI: Apnea-hypopnea index; ASV: Adaptive-servo ventilation; Bi-level PAP: Bi-level positive airway pressure; CPAP: Continuous positive airway pressure; EF: Ejection fraction; RCT: Randomized controlled trial.

Table 3 Clinical trials assessing the effects of adaptive-servo ventilation on cardiac function in heart failure patients with central sleep apnea and coexisting obstructive sleep apnea

Ref.	Study design	n	Duration (mo)	Baseline		Device usage (h)	Changes
				AHI	EF		AHI	EF
Kasai et al[40]	RCT
	CPAP	15	3	38.6	36	4.4	-23.2	1.9
	f-ASV	16		36.3	35.7	5.25	-35.4	9.1
Randerath et al[41]	RCT
	CPAP	34	12	41	43	4.3	-24.0	4.9
	f-ASV	36		47	47	5.2	-36.0	-1.9
Yoshihisa et al[42]	RCT
	Control	18	6	36	54	-	-8.2	-2.0
	v-ASV	18		37	56.1	5.6	-30.2	5.1
Birner et al[43]	RCT
	Control	35	3	43	29	-	0	3.0
	f-ASV	37		52	30	4.2	-41.0	1.0

AHI: Apnea-hypopnea index; ASV: Adaptive-servo ventilation; CPAP: Continuous positive airway pressure; EF: Ejection fraction; f-ASV: Flow-targeted ASV; v-ASV: Volume-targeted ASV; RCT: Randomized controlled trial.

Table 4 Summary of recommendations for the use of adaptive-servo ventilation in various settings

Settings	Indication	Improvement other than AHI	Supporting evidence
With SDB
HF	After optimization of HF, with CSA not suppressed by CPAP	Daytime sleepiness	RCTs (vs CPAP)[3,4,40,41,43]
		LVEF	RCTs (vs control)[36,42]
		BNP	RCT (vs Bi-level PAP)[37]
		Event-free survival
Treatment-emergent CSA	With HF	Same as HF
	Without HF	Sleep architecture	Retrospective studies (pre-post study, vs CPAP)[64,65]
		Adherence of PAP
Idiopathic CSA	With symptoms	Daytime alertness and mood	Case series (pre-post study, vs CPAP or oxygen)[5]
Opioid-induced CSA	Benefit unknown
Stroke-related CSA	Post-acute phase	Daytime sleepiness	A single-center retrospective study (pre-post study)[86]
Without SDB
HF	Regardless of the presence or absence of SDB	LVEF	A multi-center retrospective study (pre-post study)[91]
		NYHA class
Acute cardiogenic pulmonary edema	With elevated filling pressure	Dyspnea	An observational study (vs supplemental oxygen alone)[12]
		High blood pressure
Atrial fibrillation	During PVI	Procedural time	On-off study[93]

AHI: Apnea-hypopnea index; ASV: Adaptive-servo ventilation; BNP: Brain natriuretic peptide; CPAP: Continuous positive airway pressure; CSA: Central sleep apnea; HF: Heart failure; LVEF: Left ventricular ejection fraction; NYHA: New York Heart Association; PAP: Positive airway pressure; PVI: Pulmonary vein isolation; RCT: Randomized controlled trial; SDB: Sleep disordered breathing.