Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

ASV News Dated 5/15/17
#1
ASV News Dated 5/15/17
I found This ASV article I wished to share with anyone interested in newer info/news on the ASV. See below for the link access. Interesting read IMO.

Sleep article

Dave
lots-o-coffee
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#2
RE: ASV News Dated 5/15/17
Not surprising that compliance improved for patients with CPAP emergent central apnea, when switched from CPAP to ASV. As you know, we have seen a lot of misery from attempting to use the wrong therapy. We can only hope the professional community catches up and begins to recognize this problem sooner than later. Currently most doctors and sleep professionals blame their patients for failure.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#3
RE: ASV News Dated 5/15/17
While it would be nice for the medical pros to catch up, I'm not holding my breath on it.

Oh, and I certainly agree that compliance goes up when you're on the right machine. That isn't a theory, I've proved it myself.

Dave
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#4
RE: ASV News Dated 5/15/17
I'm there with you, I feel much better on ASV, as a matter of fact, I was in such dire straights with the CPAP machine that I recently gave up on it after and started setting my alarm to wake me up at the hours I tend to have the most CA events, then reset the alarm for an hour later (3am, 4am, 5am...if I was able to stay in bed that long).

I've seen the study on ASV with patients having an EF <45% and I have my own doubts, I feel so much better with the ASV machine that my heart isn't straining with all the CA events.
Post Reply Post Reply
#5
RE: ASV News Dated 5/15/17
I'm with you on that, Hojo. I'll admit I've got some sort of heart issue, but it's not ASV related, but rather high blood pressure and/or some other issue. Since I've got a cardiac specialist looking into it, and he's aware I'm using ASV, I've got precautions in place. But I'm again certain ASV is only doing good for me. I'm more readily compliant and the therapy is keeping my Mixed Apnea AHI numbers low.

Dave
lots-o-coffee
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#6
RE: ASV News Dated 5/15/17
I'm really not looking to pick a fight; but in my opinion - based on admittedly a brief membership here - is that this forum is a bit too quick to push ASV for CSA, especially treatment emergent CSA.


In particular, I think there are a couple misconceptions here about the safety signal from SERVE-HF:  

First, people with CHF and EF < 45% are not on death's door.  As a physician, I have many patients with EF < 45% who live for many years.  Some of them even have a return to normal EF.  

Second, since the medical / scientific community does not know what caused the increased risk of death with ASV in CHF patients with reduced EF, we don't know what that safety signal means for ASV safety in other groups besides the one with that heart condition.  There seems to be an assumption by many in this forum that it is definitely safe except for people with that heart condition, but sleep medicine experts by and large do not agree with that assumption.  


https://www.uptodate.com/contents/centra...ntributors Wrote:ASV remains an option in patients with hyperventilation-related CSA and a preserved ejection fraction, although treatment decisions in such patients should be individualized, and there is a paucity of direct data in these patients [15]. 

Patients who are already using ASV for other indications (eg, heart failure with preserved ejection fraction, primary CSA, treatment-emergent CSA) should be informed about the safety signal from the SERVE-HF trial; in some cases the balance of risks and benefits may still favor ASV therapy, particularly in patients who are responding to therapy and have failed prior CPAP.


As an aside, by extension many experts also have concerns about BPAP-ST safety - especially in patients with CHF and reduced EF - since it has in common with ASV the use of bilevel PAP with backup rate.


None of this is to say that ASV is the wrong choice for CSA, whether treatment-emergent or otherwise.  All I am saying is that when a sleep specialist suggests an extended trial of CPAP before a form of bilevel with backup (whether that be ASV or BPAP-ST), it may not have anything to do with them lagging behind the science, being ignorant of studies, trying to save money, being lazy, or blaming patients.  

I am no sleep specialist, but I do take seriously the principal of "first, do no harm", which includes a careful consideration of both proven and unproven risks of any treatment.
Post Reply Post Reply
#7
RE: ASV News Dated 5/15/17
(12-16-2017, 09:15 AM)Shin Ryoku Wrote: I'm really not looking to pick a fight; but in my opinion - based on admittedly a brief membership here - is that this forum is a bit too quick to push ASV for CSA, especially treatment emergent CSA.


In particular, I think there are a couple misconceptions here about the safety signal from SERVE-HF:  

First, people with CHF and EF < 45% are not on death's door.  As a physician, I have many patients with EF < 45% who live for many years.  Some of them even have a return to normal EF.  

Second, since the medical / scientific community does not know what caused the increased risk of death with ASV in CHF patients with reduced EF, we don't know what that safety signal means for ASV safety in other groups besides the one with that heart condition.  There seems to be an assumption by many in this forum that it is definitely safe except for people with that heart condition, but sleep medicine experts by and large do not agree with that assumption.  


https://www.uptodate.com/contents/centra...ntributors Wrote:ASV remains an option in patients with hyperventilation-related CSA and a preserved ejection fraction, although treatment decisions in such patients should be individualized, and there is a paucity of direct data in these patients [15]. 

Patients who are already using ASV for other indications (eg, heart failure with preserved ejection fraction, primary CSA, treatment-emergent CSA) should be informed about the safety signal from the SERVE-HF trial; in some cases the balance of risks and benefits may still favor ASV therapy, particularly in patients who are responding to therapy and have failed prior CPAP.


As an aside, by extension many experts also have concerns about BPAP-ST safety - especially in patients with CHF and reduced EF - since it has in common with ASV the use of bilevel PAP with backup rate.


None of this is to say that ASV is the wrong choice for CSA, whether treatment-emergent or otherwise.  All I am saying is that when a sleep specialist suggests an extended trial of CPAP before a form of bilevel with backup (whether that be ASV or BPAP-ST), it may not have anything to do with them lagging behind the science, being ignorant of studies, trying to save money, being lazy, or blaming patients.  

I am no sleep specialist, but I do take seriously the principal of "first, do no harm", which includes a careful consideration of both proven and unproven risks of any treatment.


I do see that you use one. For what reason?
Post Reply Post Reply
#8
RE: ASV News Dated 5/15/17
Shin Ryoku, I don't think anyone is pushing for ASV unless it's called for. The problem is the average sleep center out there is a cookie factory pumping out prescriptions for CPAP's. They don't take the time to actually look at progress of the patients but are more concerned about the patient getting his 4 hours a day on the machine so the insurance will continue to play the bills.

Are there good Sleep Doctors out there? Sure. But not enough! I don't know if it's because they're overloaded or if it's because sleep medicine as become a landing spot for mediocre Doctors. Probably a little of both.
Download SleepyHead
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



Post Reply Post Reply
#9
RE: ASV News Dated 5/15/17
In fairness to Shin, he did say "treatment emergent CSA"
I did post a video of a leading doctor lecturing other doctors on asv. In it he said that most pressure induced ca resolve and asv isn't needed/then needed. This is also seen on the forum and is often said by 3 months.

The death rate was related to the ejection factor, the worse it was the more they died. As Shin said, it was observational and speculative on why they died. There are some ideas.
I would recommend anyone interested in asv to watch the main asv videos on this page
https://www.youtube.com/user/emjreviews/videos

My personal view is if you want one, get one, I also got a VAPS while I was at it. A good question to answer with an o2 recorder is, are the induced CA causing o2 desaturations? I would guess most cases they don't
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
Post Reply Post Reply
#10
RE: ASV News Dated 5/15/17
(12-16-2017, 09:53 AM)jerry1967 Wrote: I do see that you use one. For what reason?


I use BPAP without a backup rate.  Not ASV.  I changed to a BPAP machine mainly to see if I'd feel more comfortable with a little pressure support.  My current minimum EPAP is 17, and I'm still working out how much PS is optimal for my comfort and for my central apnea index (I have some treatment-emergent CAs without meeting the criteria for diagnosis of treatment-emergent CSA).
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  [News] Apnea Board News 2023 email copy SuperSleeper 0 643 10-10-2023, 12:32 AM
Last Post: SuperSleeper
  FYI: PHILLIPS NEWS srlevine1 0 576 10-24-2022, 02:53 AM
Last Post: srlevine1
  [News] Apnea Board News - 2022 SuperSleeper 0 791 06-27-2022, 10:05 PM
Last Post: SuperSleeper
  Phillips DreamStation 1 News? Mutineer 0 822 05-04-2021, 09:03 PM
Last Post: Mutineer
  [News] April 2021 ResMed news SarcasticDave94 5 997 04-06-2021, 08:37 PM
Last Post: sheepless
  Interesting mask fit news from Phillips Gooserider 5 1,302 05-24-2020, 03:55 PM
Last Post: Gideon
  Good news with side sleeping renoir 6 1,400 01-03-2020, 11:11 PM
Last Post: SleepyTexasGirl


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.