AUTHOR=Cantero Chloé , Adler Dan , Pasquina Patrick , Uldry Christophe , Egger Bernard , Prella Maura , Younossian Alain Bigin , Poncet Antoine , Soccal-Gasche Paola , Pepin Jean-Louis , Janssens Jean-Paul 

TITLE=Adaptive Servo-Ventilation: A Comprehensive Descriptive Study in the Geneva Lake Area

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00105

DOI=10.3389/fmed.2020.00105

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Use of adaptive servo-ventilation (ASV) has been questioned in patients with central sleep apnea (CSA) and chronic heart failure (CHF). This study aims to detail the present use of ASV in clinical practice.</p><p><bold>Methods:</bold> Descriptive, cross-sectional, multicentric study of patients undergoing long term (≥3 months) ASV in the Cantons of Geneva or Vaud (1,288,378 inhabitants) followed by public or private hospitals, private practitioners and/or home care providers.</p><p><bold>Results:</bold> Patients included (458) were mostly male (392; 85.6%), overweight [BMI (median, IQR): 29 kg/m<sup>2</sup> (26; 33)], comorbid, with a median age of 71 years (59–77); 84% had been treated by CPAP before starting ASV. Indications for ASV were: emergent sleep apnea (ESA; 337; 73.6%), central sleep apnea (CSA; 108; 23.6%), obstructive sleep apnea (7; 1.5%), and overlap syndrome (6; 1.3%). Origin of CSA was cardiac (<italic>n</italic> = 30), neurological (<italic>n</italic> = 26), idiopathic (<italic>n</italic> = 28), or drug-related (<italic>n</italic> = 22). Among CSA cases, 60 (56%) patients had an echocardiography within the preceding 12 months; median left ventricular ejection fraction (LVEF) was 62.5% (54–65); 11 (18%) had a LVEF ≤45%. Average daily use of ASV was [mean (SD)] 368 (140) min; 13% used their device &lt;3:30 h. Based on ventilator software, apnea-hypopnea index was normalized in 94% of subjects with data available (94% of 428).</p><p><bold>Conclusions:</bold> Use of ASV has evolved from its original indication (CSA in CHF) to a heterogeneous predominantly male, aged, comorbid, and overweight population with mainly ESA or CSA. CSA in CHF represented only 6.5% of this population. Compliance and correction of respiratory events were satisfactory.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>, identifier: NCT04054570.</p>