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Analysis of cardiopulmonary coupling to assess adaptive servo-ventilation success in complex sleep apnea management

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Abstract

Background

Adaptive servo-ventilation (ASV) is used to treat complex sleep apnea syndrome (CompSAS), but with variable success. Factors influencing success are poorly understood. ASV devices determine their output based upon characteristics of a given breath and on proprietary algorithms that assume a periodic breathing pattern. Periodic breathing patterns produce elevated narrow band low-frequency cardiopulmonary coupling (eNB-LFC). Therefore, we hypothesized that ASV success would correlate with elevated proportions of periodic breathing as marked by eNB-LFC on cardiopulmonary coupling (CPC) analysis.

Methods

This was a retrospective study of 106 consecutive patients presenting to an academic tertiary care sleep center with CompSAS between July 2008 and July 2009 who underwent ASV titration with polysomnographic signals amenable to CPC analysis.

Results

The study included 89 males (84 %) and 17 females (16 %), with mean age of 63.3 years. Median diagnostic apnea–hypopnea index (AHI) was 38 (21, 56)/h, and on continuous positive airway pressure (CPAP), the median residual AHI (CompSAS) was 36.5 (23, 58)/h, with central apneas occurring on average 22.5 (13, 39)/h. ASV brought AHI to 11.0 ± 13.0, with success in 81.1 % of patients, as defined by an AHI of <10/h. NB-LFC was elevated (>0) in 45.3 %; however, the percentage of eNB-LFC did not correlate with ASV treatment success (p = 0.518). No clinical factors were found to be associated with ASV success.

Conclusion

ASV was successful in 81 % of patients with CompSAS. However, eNB-LFC calculated from CPC, a marker for periodic breathing, did not correlate with ASV success and therefore may not be a useful tool to predict ASV success.

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References

  1. Pepperell JC, Maskell NA, Jones DR, Langford-Wiley BA, Crosthwaite N, Stradling JR, Davies RJ (2003) A randomized controlled trial of adaptive ventilation for Cheyne–Stokes breathing in heart failure. Am J Respir Crit Care Med 168:1109–1114

    Article  PubMed  Google Scholar 

  2. Philippe C, Stoica-Herman M, Drouot X, Raffestin B, Escourrou P, Hittinger L, Michel PL, Rouault S, d’Ortho MP (2006) Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne–Stokes respiration in heart failure over a six month period. Heart 92:337–342

    Article  PubMed  CAS  Google Scholar 

  3. Teschler H, Dohring J, Wang YM, Berthon-Jones M (2001) Adaptive pressure support servo-ventilation: a novel treatment for Cheyne–Stokes respiration in heart failure. Am J Respir Crit Care Med 164:614–619

    Article  PubMed  CAS  Google Scholar 

  4. Farney RJ, Walker JM, Cloward TV, Rhondeau S (2003) Sleep-disordered breathing associated with long-term opioid therapy. Chest 123:632–639

    Article  PubMed  Google Scholar 

  5. Teichtahl H, Prodromidis A, Miller B, Cherry G, Kronborg I (2001) Sleep-disordered breathing in stable methadone programme patients: a pilot study. Addiction 96:395–403

    Article  PubMed  CAS  Google Scholar 

  6. Walker JM, Farney RJ, Rhondeau SM, Boyle KM, Valentine K, Cloward TV, Shilling KC (2007) Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J Clin Sleep Med 3:455–461

    PubMed  Google Scholar 

  7. Wang D, Teichtahl H, Drummer O, Goodman C, Cherry G, Cunnington D, Krongborg I (2005) Central sleep apnea in stable methadone maintenance treatment patients. Chest 128:1348–1356

    Article  PubMed  Google Scholar 

  8. Allam JS, Olson EJ, Gay PC, Morgenthaler TI (2007) Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes. Chest 132:1839–1846

    Article  PubMed  Google Scholar 

  9. Banno K, Okamura K, Kryger MH (2006) Adaptive servo-ventilation in patients with idiopathic Cheyne–Stokes breathing. J Clin Sleep Med 2:181–186

    PubMed  Google Scholar 

  10. Bitter T, Westerheide N, Faber L, Hering D, Prinz C, Langer C, Horstkotte D, Oldenburg O (2010) Adaptive servoventilation in diastolic heart failure and Cheyne–Stokes respiration. Eur Respir J 36:385–392

    Article  PubMed  CAS  Google Scholar 

  11. Bitter T, Westerheide N, Hossain MS, Lehmann R, Prinz C, Kleemeyer A, Horstkotte D, Oldenburg O (2011) Complex sleep apnoea in congestive heart failure. Thorax 66:402–407

    Article  PubMed  Google Scholar 

  12. Kasai T, Usui Y, Yoshioka T, Yanagisawa N, Takata Y, Narui K, Yamaguchi T, Yamashina A, Momomura SI, Investigators JASV (2010) Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne–Stokes respiration. Circ Heart Fail 3:140–148

    Article  PubMed  Google Scholar 

  13. Zhang XL, Yin KS, Li XL, Jia EZ, Su M (2006) Efficacy of adaptive servoventilation in patients with congestive heart failure and Cheyne–Stokes respiration. Chin Med J (Engl) 119:622–627

    Google Scholar 

  14. Lorenzi-Filho G, Dajani HR, Leung RS, Floras JS, Bradley TD (1999) Entrainment of blood pressure and heart rate oscillations by periodic breathing. Am J Respir Crit Care Med 159:1147–1154

    Article  PubMed  CAS  Google Scholar 

  15. Leung RS, Floras JS, Lorenzi-Filho G, Rankin F, Picton P, Bradley TD (2003) Influence of Cheyne–Stokes respiration on cardiovascular oscillations in heart failure. Am J Respir Crit Care Med 167:1534–1539

    Article  PubMed  Google Scholar 

  16. Leung RS, Bradley TD (2003) Respiratory modulation of heart rate and blood pressure during Cheyne–Stokes respiration. J Electrocardiol 36(Suppl):213–217

    Article  PubMed  Google Scholar 

  17. Thomas RJ, Mietus JE, Peng CK, Goldberger AL (2005) An electrocardiogram-based technique to assess cardiopulmonary coupling during sleep. Sleep 28:1151–1161

    PubMed  Google Scholar 

  18. Thomas RJ, Mietus JE, Peng CK, Gilmartin G, Daly RW, Goldberger AL, Gottlieb DJ (2007) Differentiating obstructive from central and complex sleep apnea using an automated electrocardiogram-based method. Sleep 30:1756–1769

    PubMed  Google Scholar 

  19. Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specification. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  20. (1992) EEG arousals: scoring rules and examples; a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–184

  21. Randerath WJ, Galetke W, Stieglitz S, Laumanns C, Schafer T (2008) Adaptive servo-ventilation in patients with coexisting obstructive sleep apnoea/hypopnoea and Cheyne–Stokes respiration. Sleep Med 9:823–830

    Article  PubMed  Google Scholar 

  22. Ramar K, Ramar P, Morgenthaler TI (2012) Adaptive servo-ventilation in patients with central or complex sleep apnea related to chronic opioid use and congestive heart failure. J Clin Sleep Med 8(5):1–8

    Google Scholar 

  23. Berthon-Jones M (2006) Ventilatory assistance for treatment of cardiac failure and Cheyne–Stokes breathing. US Patent 7,077,132 B2 filed June 11, 2004

  24. Kuzniar TJ, Patel S, Nierodzik CL, Smith LC (2011) Comparison of two servo ventilator devices in the treatment of complex sleep apnea. Sleep Med 12:538–541

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55901, USA

    Kannan Ramar & Timothy I. Morgenthaler

  2. Service de Pneumologie Centre Hospitalier Universitaire, 35033, Rennes Cedex, France

    Benoît Desrues

  3. Health Science Research, Mayo Clinic, Rochester, MN, 55901, USA

    Priya Ramar

Authors
  1. Kannan Ramar
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  2. Benoît Desrues
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  3. Priya Ramar
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  4. Timothy I. Morgenthaler
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Correspondence to Kannan Ramar.

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Ramar, K., Desrues, B., Ramar, P. et al. Analysis of cardiopulmonary coupling to assess adaptive servo-ventilation success in complex sleep apnea management. Sleep Breath 17, 861–866 (2013). https://doi.org/10.1007/s11325-012-0780-5

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  • DOI: https://doi.org/10.1007/s11325-012-0780-5

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