Therapy-efficacy of a new mode of automatic servo ventilation in subjects with complicated breathing patterns during sleep

Introduction: Cheyne-Stokes respiration (CSR) is a form of sleep disordered breathing (central apnea, periodic breathing) seen in approximately 40% of congestive heart failure patients with a left ventricular ejection fraction less than 40%.CSR is an independent risk factor for death. Auto SV is a mode of pressure support to treat obstructive, central and complex breathing patterns during sleep which may be seen in patients with CHF. The aim of the study was to determine if the Auto SV device adequately treated CSA and CSR. We evaluated the efficacy of an enhanced AutoSV algorithm in previously untreated patients with heart failure and central apnea.
Methods: After providing consent, participants had a diagnostic polysomnography followed by a full night of treatment on the enhanced BiPAP autoSV ADVANCED (Respironics, Murrysville, PA USA) algorithm to determine the effect of treatment on the respiratory disturbance index (RDI), central apnea index (CAI), CSR, apnea-hypopnea index (AHI) during both REM and non-REM sleep, hypopnea index (HI) and respiratory arousals. The device was set to automatically determine expiratory and inspiratory pressures and a minimum respiratory rate with maximum pressures limits available. A maximum expiratory pressure
relief setting of 3 was provided. Data were analyzed with paired t-tests.
Results: Data (mean ± SD) are presented on eight male participants. The average age was 67±12.4 years, BMI was 29.2± 5.8 Kg/m2 and the ejection fraction was 25.3% ± 5.6. Sleep time and sleep efficiency were not significantly different. The RDI on the treatment night (5.2±4.9 events per hour) was significantly lower (p=0.0001) than that on the diagnostic night (45.4±13.6 events per hour). The enhanced AutoSV also lowered the CAI (0.5±1.0 vs. 20.9±16.7, (p=0.01)), the CSR Index (1.0±3.0 vs. 26.1±17, (p=0.002)). The AHI during REM with treatment (2.8± 3.3) was significantly lower than that during the diagnostic PSG(21.6±19.9. (p=0.032)). There was a significant reduction in the AHI during non-REM as well (AHI with treatment = 5.7±5.7 and 48.3±13.8 without
treatment, p=0.0001). The HI was 4.3±3.9 with therapy compared to 17.1±10.8 on the diagnostic night (p=0.018) and the respiratory arousal index (5.3±5.8 vs. 95.8±69, (p=0.007)) decreased significantly.
Conclusion: These data indicate that the enhanced Auto SV algorithm successfully treats central apnea and Cheyne-Stokes respiration in patients with severe heart failure.
Support (If Any): Support provided by Philips Respironics.