A novel adaptive servoventilation (ASVAuto) for the treatment of central sleep apnea associated with chronic use of opioids

Abstract

Study objectives: To compare the efficacy and patient comfort of a new mode of minute ventilation-targeted adaptive servoventilation (ASVAuto) with auto-titrating expiratory positive airway pressure (EPAP) versus bilevel with back-up respiratory rate (bilevel-ST) in patients with central sleep apnea (CSA) associated with chronic use of opioid medications.

Methods: Prospective, randomized, crossover polysomnography (PSG) study. Eighteen consecutive patients (age ≥ 18 years) who had been receiving opioid therapy (≥ 6 months), and had sleep disordered breathing with CSA (central apnea index [CAI] ≥ 5) diagnosed during an overnight sleep study or positive airway pressure (PAP) titration were enrolled to undergo 2 PSG studies-one with ASVAuto and one with bilevel-ST. Patients completed 2 questionnaires after each PSG; Morning After Patient Satisfaction Questionnaire and PAP Comfort Questionnaire.

Results: Patients had a mean age of 52.9 ± 15.3 years. PSG prior to randomization showed an apnea hypopnea index (AHI) of 50.3 ± 22.2 and CAI of 13.0 ± 18.7. Titration with ASVAuto versus bilevel-ST showed that there were significant differences with respect to AHI and CAI. The AHI and CAI were significantly lower on ASVAuto than bilevel-ST (2.5 ± 3.5 versus 16.3 ± 20.9 [p = 0.0005], and 0.4 ± 0.8 versus 9.4 ± 18.8 [p = 0.0002], respectively). Respiratory parameters were normalized in 83.3% of patients on ASVAuto versus 33.3% on bilevel-ST. Patients felt more awake and alert on ASVAuto than bilevel-ST based on scores from Morning After Patient Satisfaction Questionnaire (p = 0.0337).

Conclusions: The ASVAuto was significantly more effective than bilevel-ST for the treatment of CSA associated with chronic opioid use.

Keywords: ASV; CSA; adaptive servoventilation; bilevel; bilevel-ST; central sleep apnea; opioids; positive airway pressure; sleep apnea.

Figure 1. Comparison of AHI and CAI with ASVAuto and bilevel with back-up rate in the total patient group.

There was a significant reduction in total number of abnormal breathing events during sleep (AHI and CAI) with ASVAuto compared to bilevel with back-up respiratory rate. PSG, polysomnography; AHI, apnea hypopnea index; CAI, central apnea index. * p < 0.001.