A Novel Adaptive Servoventilation (ASVAuto) for the Treatment of Central Sleep Apnea Associated with Chronic Use of Opioids

Study Objectives: To compare the efficacy and patient comfort of a new mode of minute ventilation-targeted adaptive servoventilation (ASVAuto) with auto-titrating expiratory positive airway pressure (EPAP) versus bilevel with back-up respiratory rate (bilevel-ST) in patients with central sleep apnea (CSA) associated with chronic use of opioid medications. Methods: Prospective, randomized, crossover polysomnography (PSG) study. Eighteen consecutive patients (age >= 18 years) who had been receiving opioid therapy (>= 6 months), and had sleep disordered breathing with CSA (central apnea index [CAI] >= 5) diagnosed during an overnight sleep study or positive airway pressure (PAP) titration were enrolled to undergo 2 PSG studies-one with ASVAuto and one with bilevel-ST. Patients completed 2 questionnaires after each PSG; Morning After Patient Satisfaction Questionnaire and PAP Comfort Questionnaire. Results: Patients had a mean age of 52.9 +/- 15.3 years. PSG prior to randomization showed an apnea hypopnea index (AHI) of 50.3 +/- 22.2 and CAI of 13.0 +/- 18.7. Titration with ASVAuto versus bilevel-ST showed that there were significant differences with respect to AHI and CAI. The AHI and CAI were significantly lower on ASVAuto than bilevel-ST (2.5 +/- 3.5 versus 16.3 +/- 20.9 [p = 0.0005], and 0.4 +/- 0.8 versus 9.4 +/- 18.8 [p = 0.0002], respectively). Respiratory parameters were normalized in 83.3% of patients on ASVAuto versus 33.3% on bilevel-ST. Patients felt more awake and alert on ASVAuto than bilevel-ST based on scores from Morning After Patient Satisfaction Questionnaire (p = 0.0337). Conclusions: The ASVAuto was significantly more effective than bilevel-ST for the treatment of CSA associated with chronic opioid use.