Treatment of Complex Sleep Apnea with Bilevel Positive Airway Pressure Vs Adaptive Servo Ventilation

BPAP and ASV have been shown to improve SDB in patients with CSA (38). The best approach for treatment of CompSA patients remains unclear but one study pursued this issue comparing the response for both BPAP and the newly approved VPAP Adapt™, Adapt Servo Ventilator or ASV (ResMed, Poway, CA) (39). This study investigated 21 adult patients (95% male) with CSA/CSR mixed apnea or CompSA who had previously undergone diagnostic PSG and titration with PAP in a randomized crossover design. Patients with a diagnostic AHI = 54.7 ± 23.8 events/hour, mean age and BMI of 65 ± 12.4 (SD) years and 31.0 ± 4.9 kg/m2, respectively, were randomly assigned initially to either BPAP or ASV during two full-night PSG studies. Following previously attempted optimal titration with CPAP, the CompSA patients (n=15) had a mean AHI > 30 but with either BPAP or ASV the AHI improved markedly from baseline to 6.2 ± 7.6 events/hour or 0.8 ± 2.4 events/hour, respectively. The treatment arms were different; however based on the preselected endpoints of the AHI and respiratory arousal index proving to be significantly superior for ASV (p < 0.02). The authors concluded that both BPAP and ASV seem to be effective in the acute setting for treatment of SDB in patients with CompSA and far more efficacious than CPAP alone but the CompSA patients seemed to respond optimally to ASV. A classic example of a CompSA patient response at baseline, treated with CPAP, and then the improvement with ASV can been seen in Figures 3 to 5, respectively.

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