A failure of adaptive servo-ventilation to correct central apneas in cheyne-stokes breathing

Harigopal Reddy, Thomas A Dillard

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

An 80-year-old man with severe central sleep apnea due to Cheyne-Stokes breathing (AHI 41.2) caused by severe cardiac failure underwent a trial of adaptive servo-ventilation (ASV) by full face mask after failure of a fixed CPAP trial. Recommended procedure was closely followed and the ASV device activated normally during central apneas. Initial settings were EEP 5, PSmin 3, PSmax 15 on room air. The device did not capture the thorax or abdomen, as shown by lack of change in respiratory inductive plethysmography, despite expected mask pressure waveforms. Snoring was also detected during apneas with device activation. Desaturation continued, followed by arousals during hyperpnea. On the device, the patient clearly slept for 1-3 epochs during the central apneas only to awaken during hyperpnea. We hypothesize that the failure to capture may have resulted from "reverse" obstructive apnea, possibly due to glottic closure during ASV activation. We suggest that earlier manual adjustments to ASV in cases such as ours, prior to waiting for the recommended 20 to 40 min of sleep, may be appropriate in selected patients. We also consider additional interventions that may increase the likelihood of a successful trial.

Original languageEnglish (US)
Pages (from-to)103-106
Number of pages4
JournalJournal of Clinical Sleep Medicine
Volume8
Issue number1
DOIs
StatePublished - Mar 2 2012

Fingerprint

Central Sleep Apnea
Ventilation
Respiration
Equipment and Supplies
Apnea
Masks
Social Adjustment
Snoring
Plethysmography
Arousal
Tongue
Abdomen
Sleep
Thorax
Heart Failure
Air
Pressure

Keywords

  • Adaptive servo-ventilation
  • Central sleep apnea
  • Cheyne stokes breathing
  • Continuous positive airway pressure

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

A failure of adaptive servo-ventilation to correct central apneas in cheyne-stokes breathing. / Reddy, Harigopal; Dillard, Thomas A.

In: Journal of Clinical Sleep Medicine, Vol. 8, No. 1, 02.03.2012, p. 103-106.

Research output: Contribution to journalArticle

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