First experience of using new adaptive servo-ventilation device for Cheyne-Stokes respiration with central sleep apnea among Japanese patients with congestive heart failure - Report of 4 clinical cases

Background Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) in congestive heart failure (CHF) is generally considered a poor prognostic indicator, but treatment of CSR-CSA using an adaptive servo-ventilation (ASV) device has been developed. This is the first evaluation of its use in the management of CSR-CSA in Japanese CHF patients. Methods and Results Four CHF patients with CSR-CSA that was unresponsive to conventional positive airway pressure (CPAP) underwent 3 nights of polysomnography: baseline, CPAP or bi-level PAP, and on the ASV. The apnea-hypopnea index (AHI) and central-AHI (CAHI) were markedly improved on ASV (AHI 62.7 +/- 10.1 to 5.9 +/- 2.2 /h, p=0.0006, CAHI 54.5 +/- 6.7 to 5.6 +/- 2.3 /h, p=0.007). In addition, the sleep quality improved significantly on ASV, including arousal index (62.0 +/- 10.5 to 18.7 +/- 6.2/h, p=0.012), percentage of slow-wave sleep (2.6 +/- 2.6 to 19.4 +/- 4.8 %, p=0.042). Conclusions ASV markedly improved CSR-CSA in patients with CHF. It is a promising treatment for Japanese patients with CHF.