ArticleFederal practitioner : for the health care professionals of the VA, DoD, and PHS2023
Experience With Adaptive Servo-Ventilation Among Veterans in the Post-SERVE-HF Era.
Article in Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The sleep medicine community has struggled to identify the ideal role for adaptive servo-ventilation (ASV) therapy following a study that found increased mortality in patients with central sleep apnea (CSA) and heart failure with reduced ejection fraction who used ASV therapy. We aimed to identify characteristics of patients who benefit from ASV therapy. Methods: We performed a record review of all patients treated with ASV therapy at the Hampton Veterans Affairs Medical Center in Virginia from January 1, 2015, to April 30, 2020. Clinical and polysomnographic characteristics of patients adherent to therapy were compared with those that were not adherent. Results: Our cohort of 31 patients was entirely male with a mean age of 67.2 years, body mass index of 34.0, and Epworth Sleepiness Scale score of 10.9. Primary CSA was initially diagnosed in 3 patients (10%), comorbid obstructive sleep apnea (OSA) and CSA in 9 (29%), and primary OSA in 19 (61%). Seventeen patients (55%) met minimal adherence criteria with ASV therapy. The obstructive apnea-hypopnea index (AHI), as a proportion of the total pretreatment AHI, was higher in adherent patients (81.5%) vs nonadherent patients (46.7%) ( Conclusions: Patients using ASV devices regularly have a larger component of obstructive sleep-disordered breathing and obtain greater objective benefit from ASV than those that do not. This understanding may help to identify patients that will most benefit from this debated form of therapy.
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