What is the remaining status of adaptive servo-ventilation? The results of a real-life multicenter study (OTRLASV-study) : Adaptive servo-ventilation in real-life conditions

Dany Jaffuel, Carole Philippe, Claudio Rabec, Jean-Pierre Mallet, Marjolaine Georges, Stefania Redolfi, Alain Palot, Carey M Suehs, Erika Nogue, Nicolas Molinari, Arnaud Bourdin, Dany Jaffuel, Carole Philippe, Claudio Rabec, Jean-Pierre Mallet, Marjolaine Georges, Stefania Redolfi, Alain Palot, Carey M Suehs, Erika Nogue, Nicolas Molinari, Arnaud Bourdin

Abstract

Backgrounds: As a consequence of the increased mortality observed in the SERVE-HF study, many questions concerning the safety and rational use of ASV in other indications emerged. The aim of this study was to describe the clinical characteristics of ASV-treated patients in real-life conditions.

Methods: The OTRLASV-study is a prospective, 5-centre study including patients who underwent ASV-treatment for at least 1 year. Patients were consecutively included in the study during the annual visit imposed for ASV-reimbursement renewal.

Results: 177/214 patients were analysed (87.57% male) with a median (IQ25-75) age of 71 (65-77) years, an ASV-treatment duration of 2.88 (1.76-4.96) years, an ASV-usage of 6.52 (5.13-7.65) hours/day, and 54.8% were previously treated via continuous positive airway pressure (CPAP). The median Epworth Scale Score decreased from 10 (6-13.5) to 6 (3-9) (p < 0.001) with ASV-therapy, the apnea-hypopnea-index decreased from 50 (38-62)/h to a residual device index of 1.9 (0.7-3.8)/h (p < 0.001). The majority of patients were classified in a Central-Sleep-Apnea group (CSA; 59.3%), whereas the remaining are divided into an Obstructive-Sleep-Apnea group (OSA; 20.3%) and a Treatment-Emergent-Central-Sleep-Apnea group (TECSA; 20.3%). The Left Ventricular Ejection Fraction (LVEF) was > 45% in 92.7% of patients. Associated comorbidities/etiologies were cardiac in nature for 75.7% of patients (neurological for 12.4%, renal for 4.5%, opioid-treatment for 3.4%). 9.6% had idiopathic central-sleep-apnea. 6.2% of the patients were hospitalized the year preceding the study for cardiological reasons. In the 6 months preceding inclusion, night monitoring (i.e. polygraphy or oximetry during ASV usage) was performed in 34.4% of patients, 25.9% of whom required a subsequent setting change. According to multivariable, logistic regression, the variables that were independently associated with poor adherence (ASV-usage ≤4 h in duration) were TECSA group versus CSA group (p = 0.010), a higher Epworth score (p = 0.019) and lack of a night monitoring in the last 6 months (p < 0.05).

Conclusions: In real-life conditions, ASV-treatment is often associated with high cardiac comorbidities and high compliance. Future research should assess how regular night monitoring may optimize devices settings and patient management.

Trial registration: The OTRLASV study is registered on ClinicalTrials.gov (Identifier: NCT02429986 ) on 1 April 2015.

Keywords: Adaptive servo-ventilation; CPAP; Central sleep apnea; Chronic heart failure; Obstructive sleep apnea; Sleep-disordered breathing; Treatment emergent central sleep apnea.

Conflict of interest statement

Dr. Dany Jaffuel has performed lecturing at sponsored meetings for the following companies in the last 5 years: Apard, Bastide, Loewenstein Medical, Philips, SEFAM. He has sat on advisory boards for the following companies in the last 5 years: Lowenstein Medical, SEFAM. He has received sponsorship support to attend academic meetings in the last 5 years from Lowenstein Medical, Resmed, Philips and SEFAM.

- Dr. Alain Palot has performed lecturing at sponsored meetings for the following companies in the last 5 years: ARARD, Resmed, Philips. He has sat on advisory boards for the following company in the last 5 years: Resmed

- Dr. Claudio Rabec has performed lecturing at sponsored meetings and/or participated in boards for the following companies in the last 5 years: Resmed, Philips, Lowenstein, Air Liquide Medical Systems

AB, CMS, CP, EN, JPM, NM, MG, SR report no conflicts of interest in relation to the present work.

Figures

Fig. 1
Fig. 1
Flow chart of the study. ASV: Adaptive Servo-Ventilation; AHI: Apnea Hypopnea Index; TECSA: Treatment Emergent Central Sleep Apnea; SA: Sleep Apnea, SDB: Sleep Disordered Breathing
Fig. 2
Fig. 2
Comorbidities/etiologies associated with ASV prescription. The number and percentages of the total population are presented (1 patient = 0.6%). For 33 patients (18.6%), no comorbidity was related to SA
Fig. 3
Fig. 3
Exams (polygraphy (PG) or oximetry) performed in the 6 months preceding study inclusion, depending of the ASV-initiation date

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Source: PubMed

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