Skip to main content

Advertisement

SpringerLink
Log in

Adaptive pressure support servoventilation: a novel treatment for residual sleepiness associated with central sleep apnea events

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Objective

Nasal continuous positive airway pressure (nCPAP) usually reduces sleepiness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, even with regular use of nCPAP, some OSAHS patients experience residual sleepiness (RS). The aim of this study was to evaluate the efficacy of adaptive servoventilation (ASV) on RS in OSAHS patients.

Patients and methods

The Epworth Sleepiness Scale (ESS) score was used for assessment of RS. Following correct application of 1-month auto-CPAP (APAP) treatment and exclusion for other sleepiness-associated disorders, 42 RS patients with severe OSAS were recruited. All of them received 1-week ASV treatment with auto-CS2 ventilator. Comparisons between APAP and ASV treatments were made for the following data: polysomnographic parameters including apnea hypopnea index (AHI), central sleep apnea index (CSAI), micro-arousal index (MAI), minimal pulse oxygen saturation, etc.; daytime ESS score.

Results

Compared with the parameters on day 30 of APAP treatment, there was a further significant decrease in AHI, CSAI, MAI, and daytime ESS score (P < 0.01) on day 7 of ASV treatment. ESS score before ASV treatment (10.89 ± 0.40) reduced to normal range (3.98 ± 1.26) on day 7 of ASV treatment (P < 0.01).

Conclusion

ASV treatment could significantly improved RS in OSAS patients; the mechanism of such an efficacy might be associated with further declined levels of AHI, CSAI, and arousal index.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Mulgrew AT, Lawati NA, Ayas NT, Fox N, Hamilton P, Cortes L, Ryan CF (2010) Residual sleep apnea on polysomnography after 3 months of CPAP therapy: clinical implications, predictors and patterns. Sleep Med 11(2):119–125

    Article  PubMed  Google Scholar 

  2. Pépin JL, Viot-Blanc V, Escourrou P, Racineux JL, Sapene M, Lévy P, Dervaux B, Lenne X, Mallart A (2009) Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study. Eur Respir J 33(5):1062–1067

    Article  PubMed  Google Scholar 

  3. Koutsourelakis I, Perraki E, Economou NT, Dimitrokalli P, Vagiakis E, Roussos C, Zakynthinos S (2009) Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients. Eur Respir J 34(3):687–693

    Article  PubMed  CAS  Google Scholar 

  4. Stradling JR, Smith D, Crosby J (2007) Post-CPAP sleepiness–a specific syndrome? J Sleep Res 16(4):436–438

    Article  PubMed  Google Scholar 

  5. Nguyên XL, Rakotonanahary D, Chaskalovic J, Philippe C, Hausser-Hauw C, Lebeau B, Fleury B (2008) Residual subjective daytime sleepiness under CPAP treatment in initially somnolent apnea patients: a pilot study using data mining methods. Sleep Med 9(5):511–516

    Article  PubMed  Google Scholar 

  6. Kuźniar TJ, Morgenthaler TI (2008) Treatment of complex sleep apnea syndrome. Curr Treat Options Neurol 10(5):336–341

    Article  PubMed  Google Scholar 

  7. Yaegashi H, Fujimoto K, Abe H, Orii K, Eda S, Kubo K (2009) Characteristics of Japanese patients with complex sleep apnea syndrome: a retrospective comparison with obstructive sleep apnea syndrome. Intern Med 48(6):427–432

    Article  PubMed  Google Scholar 

  8. Hastings PC, Vazir A, Meadows GE, Dayer M, Poole-Wilson PA, McIntyre HF, Morrell MJ, Cowie MR, Simonds AK (2010) Adaptive servo-ventilation in heart failure patients with sleep apnea: a real world study. Int J Cardiol 139(1):17–24

    Article  PubMed  Google Scholar 

  9. American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689

    Google Scholar 

  10. Guilleminault C, Philip P (1996) Tiredness and somnolence despite initial treatment of obstructive sleep apnea syndrome (what to do when OSAS patients stay hypersomnolent despite treatment). Sleep 19(9S):S117–S122

    PubMed  CAS  Google Scholar 

  11. Sasayama S, Izumi T, Matsuzaki M, Matsumori A, Asanoi H, Momomura S, Seino Y, Ueshima K, CHF-HOT Study Group (2009) Improvement of quality of life with nocturnal oxygen therapy in heart failure patients with central sleep apnea. Circ J 73(7):1255–1262

    Article  PubMed  Google Scholar 

  12. Chediak AD (2005) Arousal from sleep. J Clin Sleep Med 1(2):207–208

    PubMed  Google Scholar 

  13. Asyali MH, Berry RB, Khoo MC (2002) Assessment of closed-loop ventilatory stability in obstructive sleep apnea. IEEE Trans Biomed Eng 49(3):206–216

    Article  PubMed  Google Scholar 

  14. Wellman A, Jordan AS, Malhotra A, Fogel RB, Katz ES, Schory K, Edwards JK, White DP (2004) Ventilatory control and airway anatomy in obstructive sleep apnea. Am J Respir Crit Care Med 170(11):1225–1232

    Article  PubMed  Google Scholar 

  15. Xie A, Wong B, Phillipson EA, Slutsky AS, Bradley TD (1994) Interaction of hyperventilation and arousal in the pathogenesis of idiopathic central sleep apnea. Am J Respir Crit Care Med 150(2):489–495

    PubMed  CAS  Google Scholar 

  16. Zhang XL, Yin KS, Jiang SS, Li XL, Jia EZ, Su M (2006) Efficacy of adaptive servo-ventilation in patients with congestive heart failure and Cheyne–Stokes respiration. Chin Med J 119(8):622–627

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

    Su Mei, Zhang Xilong, Huang Mao & Ding Ning

Authors
  1. Su Mei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhang Xilong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huang Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ding Ning
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhang Xilong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mei, S., Xilong, Z., Mao, H. et al. Adaptive pressure support servoventilation: a novel treatment for residual sleepiness associated with central sleep apnea events. Sleep Breath 15, 695–699 (2011). https://doi.org/10.1007/s11325-010-0424-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-010-0424-6

Keywords

Search

Navigation