adaptive servo ventilation

1. New Adaptive Servo-
Ventilation Device for
Cheyne–Stokes Respiration

2. Introduction
• Sleep-disordered breathing (SDB) poses significant challenges for
individuals with congestive heart failure (CHF).
• Among the complications, Cheyne–Stokes respiration with central
sleep apnea (CSR-CSA) and obstructive sleep apnea (OSA) often
coexist.
• Traditional treatments like continuous positive airway pressure
(CPAP) face limitations, leading to the exploration of alternative
therapies, particularly in addressing CSR-CSA.

3. Cheyne–stokes respiration with central sleep apnea (CSR-CSA) and
Obstructive sleep apnea (OSA).
• Individuals with certain medical conditions, particularly those with
congestive heart failure (CHF), may experience a combination of two
distinct types of sleep-disordered breathing patterns:
Cheyne–stokes respiration with central sleep apnea (CSR-CSA)
Obstructive sleep apnea (OSA).
• These are two different forms of irregular breathing during sleep that can
occur simultaneously in some patients.

4. • Obstructive Sleep Apnea (OSA):
• OSA, on the other hand, involves the recurrent partial or complete obstruction of the upper airway during
sleep.
• This obstruction leads to episodes of reduced airflow (hypopneas) or complete cessation of airflow
(apneas).
• OSA is often characterized by loud snoring, choking, or gasping during sleep as the individual struggles
to breathe against the blocked airway.
• Cheyne–Stokes Respiration with Central Sleep Apnea (CSR-CSA):
• CSR-CSA is characterized by a cyclical pattern of breathing that involves periods of gradually increasing
and decreasing airflow, followed by brief pauses in breathing (central sleep apneas).
• It is associated with instability in the respiratory control system, often seen in conditions like congestive
heart failure.
• Central apneas occur when the brain fails to send appropriate signals to the respiratory muscles, leading
to temporary pauses in breathing

5. Need for Alternative Therapy
• Need for Alternative Therapy Patients with CHF and CSR-CSA
commonly struggle with poor adherence to CPAP, resulting in
suboptimal outcomes.
• This presents a critical need for alternative therapeutic approaches to
improve patient compliance, prognosis, and overall quality of life.
• Enter Adaptive Servo-Ventilation (ASV), a novel intervention
designed to address the shortcomings of conventional treatments.

6. What Is Adaptive Servo-Ventilation (ASV)?
• ASV is a device similar to continuous positive airway pressure
(CPAP), bilevel positive airway pressure (BPAP) and auto positive
airway pressure (Auto-PAP) that delivers pressurized air through
tubing and face mask.
• ASV is a more specialized machine that measures patient breathing
patterns and customizes the pressure delivered to stabilize breathing
throughout the night.

7. Adaptive Servo-Ventilation (ASV)
• ASV emerges as a nocturnal positive airway pressure (PAP) therapy
equipped with innovative algorithms.
• Unlike its predecessors, ASV not only targets obstructive events but
also addresses CSR-CSA through adaptive pressure control and
automatic backup systems.
• Its breath-by-breath adjustments make it a versatile and promising
option for patients with complex sleep-disordered breathing patterns.

8. ASV Features
ASV Targets Obstructive and Central Events:
• Obstructive sleep apnea (OSA) is characterized by the partial or
complete blockage of the airway during sleep.
• Central sleep apnea (CSA) involves a lack of respiratory effort, where
the brain fails to send signals to the muscles responsible for breathing.
• CSR-CSA is a specific subtype of central sleep apnea characterized by
a cyclical pattern of gradually increasing and decreasing respiration.

9. ASV Features
Adaptive Pressure Control:
• ASV employs adaptive pressure control, meaning it dynamically
adjusts the air pressure delivered based on the patient's breathing
patterns.
• When an obstructive event is detected, ASV increases the pressure to
prevent airway collapse.
• In the context of CSR-CSA, where the breathing pattern has a distinct
cycle, ASV adapts its pressure support to assist the patient during
periods of reduced or absent respiratory effort.

10. ASV Features
Automatic Backup Systems:
• ASV is equipped with automatic backup systems to ensure that the patient receives adequate
ventilation even in the absence of spontaneous breathing efforts.
• This feature is particularly important in addressing CSR-CSA, where central apneas or
hypopneas may occur, and the automatic backup helps maintain a consistent respiratory rate

11. Researches on the effectiveness of ASV
• Methods To explore the effectiveness of ASV, a systematic literature search was conducted using
MEDLINE (PubMed and Ovid).
• The focus was on clinical trials involving ASV and CSR-CSA. ASV, resembling bilevel PAP,
stands out due to its unique features tailored to CSR-CSA, making it distinct from conventional PAP
therapies.
• Results Studies, including a notable crossover study by Teschler et al. in 2001, showcase ASV's
superiority.
• Patient preferences lean towards ASV over CPAP and bilevel PAP, reflecting better outcomes in
reducing CSR-CSA episodes and improving overall sleep quality.
• These results underscore the potential of ASV in managing complex sleep-disordered breathing in
CHF patients.

12. Slide 6:
• Discussion ASV's efficacy is attributed to its dynamic pressure
adjustments and automatic backup systems.
• These features distinguish it from bilevel PAP, resulting in improved
stability of breathing patterns and enhanced cardiac function.
• The discussion further highlights the positive impact on left
ventricular ejection fraction (LVEF) and exercise tolerance,
showcasing ASV's comprehensive benefits.

13. Slide 7:
• Importance of Titration Studies While ASV holds promise, the
importance of titration studies cannot be overstated.
• Individualized adjustments are vital, as automatic algorithms may not
universally suit all patients.
• Titration ensures the precise application of ASV, optimizing its
therapeutic potential.

14. Slide 8:
• Ongoing Research To further understand ASV's long-term effects, a
large randomized controlled trial is underway in Europe.
• This study aims to determine the impact of ASV on morbidity and
mortality in CHF patients with CSR-CSA.
• The results will contribute significant insights into ASV's role as a
potential first-line therapy.

15. Slide 9: Conclusion
• In conclusion, ASV emerges as a promising first-line therapy for CSR-
CSA in CHF patients.
• Its unique features, including adaptive pressure control and automatic
backup systems, make it a compelling option for addressing complex
sleep-disordered breathing patterns.
• ASV not only improves respiratory outcomes but also positively
impacts cardiac function, making it a comprehensive solution for
patients with CHF.