User:Bob K31416/CSA

Clinical sleep disorders Carney2005

Complex Sleep Apnea Syndrome: Is It a Unique Clinical Syndrome? Morgenthaler2006 (free full text also)

The International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual 2001 (bad link)

The International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual

Upper airway mechanics Verbraecken2009 (ref 8 of Becker2010Jan)

An unusual cause of delirium Becker2010Jun

Review of Sleep Disorders Panossian2009 (ref 1 of Becker2010Jan)

ASV
 * Adaptive Pressure Support Servo-Ventilation A Novel Treatment for Cheyne-Stokes Respiration in Heart Failure 2001
 * Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period 2006
 * Central Sleep Apnea: Treatment & Medication 2010 (emedicine)
 * Adaptive Servoventilation (ASV) in Patients with Sleep Disordered Breathing Associated with Chronic Opioid Medications for Non-Malignant Pain 2008
 * Treating the "Untreatable" 2007
 * Complex Sleep Apnea: It Really Is a Disease 2008
 * Complex Sleep Apnea: It Isn’t Really a Disease 2008
 * Clinical Policy Bulletin: Noninvasive Positive Pressure Ventilation 2009 Aetna Insurance

Adaptive-Servoventilation:

Adaptive servo-ventilation (ASV), a bilevel PAP system with a backup rate feature, uses an automatic, minute ventilation-targeted device (VPAP Adapt, ResMed, Poway, CA) that performs breath to breath analysis and adjusts its settings accordingly. Depending on breathing effort, the device will automatically adjust the amount of airflow it delivers in order to maintain a steady minute ventilation. Most studies on the use of ASV have investigated its use for heart failure patients with central apnea or Cheyne-Stokes respiration (Teschler, et al., 2001; Pepperell, et al., 2003; Töpfer, et al., 2004; Pepin, et al., 2006; Kasai, et al., 2006; Zhang, et al., 2006).

Banno, et al. (2006) evaluated 3 patients with idiopathic Cheyne-Stokes breathing (CSB) and examined the feasibility of using ASV to treat them. The patients had a periodic breathing pattern resembling CSB. During polysomnography, the abnormal breathing pattern was present while patients were both awake and asleep. The patients were first tested on CPAP and/or oxygen; however they did not respond well to either of these treatments. They were then assessed on ASV. The mean abnormal breathing events index decreased from 35.2 to 3.5 per hour of sleep on ASV. There was a significant reduction in the mean number of arousals caused by abnormal breathing events: from 18.5 to 1.1 per hour of sleep. After 6 to 12 months of using ASV, the patients had maintained significant improvement in subjective daytime alertness and mood. The authors concluded that a trial of ASV for patients with idiopathic CSB is recommended if they do not have improvement in sleep respiration or daytime performance on CPAP and/or oxygen.

Morrell, et al. (2007) stated that hypercapnic cerebral vascular reactivity (HCVR) is reduced in patients with CHF and sleep-disordered breathing (SDB) and that this may be associated with an increased risk of stroke. These researchers tested the hypothesis that reversal of SDB in CHF patients using ASV would increase morning HCVR. A total of 10 CHF patients with SDB, predominantly OSA, were included in this study. The HCVR was measured from the change in middle cerebral artery velocity, using pulsed Doppler ultrasound. HCVR was determined during the evening (before) and morning (after) 1 night of sleep on ASV and 1 night of spontaneous sleep (control). Compared with the control situation, ASV decreased the AHI (group mean +/- SEM, control: 48 +/- 12, ASV: 4 +/- 1 events per hour). HCVR was 23% lower in the morning, compared with the evening, on the control night (evening: 1.3 +/- 0.2, morning: 1.0 +/- 0.2 cm/sec per mm Hg, p < 0.05) and 27% lower following the ASV night (evening: 1.5 +/- 0.2, morning: 1.1 +/- 0.2 cm/sec per mm Hg, p < 0.05). The effect of ASV on the evening-to-morning reduction in HCVR was not significant, compared with the control night (0.02 cm/sec per mm Hg, 95% confidence interval: -0.28, 0.32 p = 0.89). The authors concluded that in CHF patients with SDB, HCVR was reduced in the morning compared with the evening. However, removal of SDB for 1 night did not reverse the reduced HCVR. The relatively low morning HCVR could be linked with an increased risk of stroke.

Morgenthaler, et al. (2007) compared the efficacy of ASV versus non-invasive positive pressure ventilation (NPPV) for central, mixed, and complex sleep apnea syndromes in a prospective randomized crossover clinical trial. Twenty-one patients (6 with central sleep apnea/Cheyne-Stokes respiration, 6 with predominantly mixed apneas, and 9 with complex sleep apnea) with initial diagnostic AHI +/- standard deviation 51.9 +/- 22.8/hr and RAI 45.5 < or = 26.5/hr completed the study. Following optimal titration with CPAP (N = 15), disturbed breathing and disturbed sleep remained high with mean AHI = 34.3 +/- 25.7 and RAI = 32.1 +/- 29.7. AHI and RAI were markedly reduced with both NPPV (6.2 +/- 7.6 and 6.4 +/- 8.2) and ASV (0.8 +/- 2.4 and 2.4 +/- 4.5). Treatment AHI and RAI were both significantly lower using ASV (p < 0.01). The authors concluded that in patients with central sleep apnea/Cheyne-Stokes respiration, mixed apneas, and complex sleep apnea, both NPPV and ASV are effective in normalizing breathing and sleep parameters, and that ASV does so more effectively than NPPV in these types of patients.

Hastings, et al. (2008) assessed the use of ASV in CHF patients with all types of sleep apnea. Eleven male patients with stable CHF and sleep apnea (AHI > 15 events/h) were treated with 6 months optimized ASV and compared to 8 patients not receiving ASV. At baseline, both groups were comparable for New York Heart Association class, left ventricular ejection fraction (LVEF), plasma brain natriuretic peptide (BNP) concentrations and AHI. All patients were receiving optimal medical therapy. At 6 months, the authors reported that ASV significantly reduced AHI with improvement in LVEF and aspects of quality of life.


 * Morrell MJ, Meadows GE, Hastings P, et al. The effects of adaptive servo ventilation on cerebral vascular reactivity in patients with congestive heart failure and sleep-disordered breathing. Sleep. 2007;30(5):648-653.
 * Morgenthaler TI, Gay PC, Gordon N, et al. Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes. Sleep. 2007;30(4):468-475.
 * Hastings PC, Vazir A, Meadows GE, et al. Adaptive servo-ventilation in heart failure patients with sleep apnea: A real world study. Int J Cardiol. 2008, Sep 19. [Epub ahead of print]

Central Sleep Apnea Becker2010Jan

A Mechanism of Central Sleep Apnea in Patients with Heart Failure

Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study.

http://www.google.com/search?client=safari&rls=en&q=central+sleep+apnea+atrial+fibrillation&ie=UTF-8&oe=UTF-8

Association Between Atrial Fibrillation and Central Sleep Apnea