Dr Michael Arzt Analyzes ASV Therapy, Targets Treatment-Emergent Central Sleep Apnea With CVC

Author(s):

Michael Arzt, MD, investigated the use of ASV therapy in patients with TE-CSA and cardiovascular disease, finding it effective in reducing sleepiness and improving quality of life. It may be more suitable for some patients to be treated with ASV than CPAP due to its ability to automatically adjust pressure and potentially improve comfort.

Michael Arzt, MD, senior physician and head of the department of internal medicine at the University Hospital of Regensburg, analyzed cardiovascular comorbidities most common among patients with treatment-emergent central sleep apnea (TE-CSA). Arzt included results from the Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with adaptive servo-ventilation (READ-ASV) and the effects it had on overall sleepiness and disease related quality of life.

In research presented at the American Thoracic Society 2024 International Conference, Arzt and colleagues explored patients with TE-CSA who also had cardiovascular disease and the impacts ASV had on these patient groups.

Transcript:

How does the efficacy of READ-ASV compare with other treatments for TE-CSA?

Adaptive Servo-ventilation does fully suppress the Apnea-Hypopnea Index, which is, in patients with treatment-emergent central sleep apnea, a composite of obstructive sleep apnea (OSA) and residual central sleep apnea that emerges when you're treated with CPAP [continuous positive airway pressure]. It's more effective in treating the apneas. In our study, ASV was effective in reducing daytime sleepiness and improving disease-specific quality of life (QOL).

Are there any subgroups of patients with TE-CSA who may benefit more from ASV than others? Why or why not?

Usually, patients benefit more when the sleep apnea is worse, when they are more symptomatic, when they are more sleepy. When the burden of symptoms is higher, then the effect of the treatment is higher.

How can ASV therapy be further personalized to optimize treatment for individual patients?

ASV treatment gives the possibility to set the pressure ranges of the expiratory pressure and the inspiratory pressure support. In some patients, it's necessary to dial it down a little bit or to increase the pressure, so it can be individualized.

Adherence to CPAP therapy is a known challenge. Do you think adherence to ASV would be higher due to its automatic adjustments? How can we ensure long-term compliance?

That depends on the indication of positive airway pressure (PAP) therapy, when the indication is right and we have a patient with central sleep apnea, and importantly, in some cases with periodic breathing, the algorithm of adaptive cell ventilation is more suitable for these patients. In patients with periodic breathing, often CPAP is perceived as uncomfortable. The algorithm designed for the periodic breathing is, in many cases, more comfortable for the patients.