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Meta-Analysis
. 2016 May 15;12(5):757-61.
doi: 10.5664/jcsm.5812.

Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses"

R Nisha Aurora  1 , Sabin R Bista  2 , Kenneth R Casey  3 , Susmita Chowdhuri  4 , David A Kristo  5 , Jorge M Mallea  6 , Kannan Ramar  7 , James A Rowley  8 , Rochelle S Zak  9 , Jonathan L Heald  10
Affiliations
Meta-Analysis

Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses"

R Nisha Aurora et al. J Clin Sleep Med. .

Abstract

An update of the 2012 systematic review and meta-analyses were performed and a modified-GRADE approach was used to update the recommendation for the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnea syndrome (CSAS) related to congestive heart failure (CHF). Meta-analyses demonstrated an improvement in LVEF and a normalization of AHI in all patients. Analyses also demonstrated an increased risk of cardiac mortality in patients with an LVEF of ≤ 45% and moderate or severe CSA predominant sleep-disordered breathing. These data support a Standard level recommendation against the use of ASV to treat CHF-associated CSAS in patients with an LVEF of ≤ 45% and moderate or severe CSAS, and an Option level recommendation for the use of ASV in the treatment CHF-associated CSAS in patients with an LVEF > 45% or mild CHF-related CSAS. The application of these recommendations is limited to the target patient populations; the ultimate judgment regarding propriety of any specific care must be made by the clinician.

Keywords: adaptive servo-ventilation; central sleep apnea; clinical practice guideline.

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Figures

Figure 1
Figure 1. Evidence base flow diagram.
See this image and copyright information in PMC

Comment in

  • ASV in CHF Recommendations Too Restrictive.
    Johnson KG, Johnson DC. Johnson KG, et al. J Clin Sleep Med. 2016 Sep 15;12(9):1313-4. doi: 10.5664/jcsm.6146. J Clin Sleep Med. 2016. PMID: 27448421 Free PMC article. No abstract available.
  • Keep Calm and Debate On.
    Aurora RN, Bista SR, Casey KR, Chowdhuri S, Kristo DA, Mallea JM, Ramar K, Rowley JA, Zak RS, Heald JL. Aurora RN, et al. J Clin Sleep Med. 2016 Sep 15;12(9):1315-6. doi: 10.5664/jcsm.6148. J Clin Sleep Med. 2016. PMID: 27568903 Free PMC article. No abstract available.

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