abstract
- Positive airway pressure devices for the noninvasive treatment of sleep-disordered breathing are being marketed that have substantially expanded capabilities. Most recently, adaptive servo-ventilation devices have become available that are capable of measuring patient ventilation continuously and use that information to adjust expiratory positive airway pressure and pressure support levels to abolish central and obstructive apneas and hypopneas, including central sleep-disordered breathing of the Hunter-Cheyne-Stokes variety. Patients with congestive heart failure are particularly prone to developing central sleep apnea and/or Hunter-Cheyne-Stokes breathing, and studies have shown that suppression of these abnormal breathing patterns may improve cardiac function and, ultimately, mortality.Over the last approximately 18 months, increasing numbers of studies have appeared demonstrating improvement in cardiac function and other important outcomes after both acute application of adaptive servo-ventilation as well as 3 to 6 months of use in patients with congestive heart failure and central sleep apnea/Hunter-Cheyne-Stokes breathing. Several of these studies are randomized controlled trials and several include assessment of cardiac event-free survival showing an advantage to treating with adaptive servo-ventilation.As an adjunct to optimal pharmacological management, adaptive servo-ventilation shows considerable promise as a means to improve outcomes in patients with congestive heart failure complicated by central sleep apnea/Hunter-Cheyne-Stokes breathing. Larger randomized controlled trials will be necessary to demonstrate the ultimate role of this therapeutic modality in such patients.