[Treatment] ASV and Quality of Life

[ricknfli]

My sleep doctor discussed the possibility of my having a syndrome of "complex obstructive apnea" possibly caused by years of treatment with CPAP. He mentioned ASV as a treatment for my persistent Central Apnea not responding well to BiPAP. He said however that I might not get much relief from ASV.

I was unsure what he meant but then I found this note when searching Google for "ASV and CHF". Has anyone had experience with "there was not a benefit to quality of life with ASV" comment from RESMED?

Contact prior patients with symptomatic heart failure whom you have treated with ASV since 2005 and advise them of the risks. You should strongly consider recommending that they stop ASV treatment. Which alternative treatments for central sleep apnea to recommend, if any, will need to be individualized. The control arm of the SERVE-HF study was best medical management without management of concurrent central sleep apnea. Representatives at ResMed have indicated that in their preliminary assessment of the data, there was not quality of life benefit to therapy with ASV. Together, these indicate that at the very least, patients should ensure they are receiving best evidence-based care for their heart failure. Other evidence-based therapies to consider for CSA might include CPAP or oxygen, but long-term outcome studies for these therapies are not conclusive either. (http://aasmnet.org/articles.aspx?id=5562)

Thanks!

[Sleeprider]

Rick, if you do not have congestive heart failure, you do not need to get into this right now. We do have people that have come on the forum with severe complex apnea and Cheyne Stokes Respiration, and we have tried to help, however we quickly move away from an area where most members are comfortable discussing treatment alternatives due to the complexity of this disease, and the risks which are better assessed by a person's physicians.

If you don't have this problem, you don't want it.

[DeepBreathing]

G'day Rick

The Resmed advice is in the context of a study of patients with severe congestive heart failure, where it was found that the control group had better outcomes (ie they lived longer) than the group on ASV therapy. If you have severe congestive heart failure then ASV is not the recommended treatment, as it may actually shorten your life with no compensatory quality of life benefit. I don't know if they ever go to the bottom of why ASV therapy had this adverse outcome.

On the other hand, if you don't have CHF then ASV is a proven and very effective treatment for central sleep apnea (including complex and mixed apneas). In my case AHI came down from over 60 to typically less than 1 or 2. I have an older Resmed S9 and find that it is very effective, with a very comfortable inhale / exhale transition.

[ricknfli]

Thanks Sleeprider,

I appreciate seeing the graph. Well I do not think I have had a Cheyne-Stokes breathing pattern. I looked at the flow on my charts. I definitely have never seen the "Periodic Breathing" show up in any of my SleepyHead graphs.

I do have some shortness of breath when walking a distance, but I doubt I have congestive heart failure with a LVEF <=45. I can discuss it with the pulmonary guy I see in a couple of weeks.

Food for thought, but not for worry.

Thanks for the graph.

[ricknfli]

G'day Rick

The Resmed advice is in the context of a study of patients with severe congestive heart failure, where it was found that the control group had better outcomes (ie they lived longer) than the group on ASV therapy. If you have severe congestive heart failure then ASV is not the recommended treatment, as it may actually shorten your life with no compensatory quality of life benefit. I don't know if they ever go to the bottom of why ASV therapy had this adverse outcome.

On the other hand, if you don't have CHF then ASV is a proven and very effective treatment for central sleep apnea (including complex and mixed apneas). In my case AHI came down from over 60 to typically less than 1 or 2. I have an older Resmed S9 and find that it is very effective, with a very comfortable inhale / exhale transition.

Hi DeepBreathing,

Well I thought maybe Resmed was just speaking in terms of CHF, but since my doc mentioned what he did, that quote caught my attention.

I read some background papers on the bad effects. They got into increased ASV air pressure in the lungs and chest causing a drop in right sided heart pressures, then pulmonary CHF which could have led to worsening left ventricular CHF, etc, etc It was beyond me.

I am really glad you have had such a great drop in AHI. I assume you feel a lot better too?

My sleep study from just over a year ago showed untreated AHI of 77. I look forward to some better numbers.

[Sleeprider]

Rick the CHF is so serious, I guess I just couldn't imagine how you went there. There is no cure. It's a one way trip to the grave, and it's heartbreaking to watch, and try to care for these people as they fade away in respiratory and heart failure. I'm far too close to is as I lost my dad this way. The thing is, ASV looks like a hopeful therapy that an help with the chronic periodic breathing pattern and repeated central apnea; but the study by Resmed in 2015 that showed an increased mortality in CHF patients with left ventricle ejection factors less than 40% took that option away. So the conversation goes to, is the quality of life benefit of breathing while you sleep, worth the risk? It's a really tough question for a disease that is 100% fatal.

[richb]

My sleep doctor discussed the possibility of my having a syndrome of "complex obstructive apnea" possibly caused by years of treatment with CPAP. He mentioned ASV as a treatment for my persistent Central Apnea not responding well to BiPAP. He said however that I might not get much relief from ASV.

I was unsure what he meant but then I found this note when searching Google for "ASV and CHF". Has anyone had experience with "there was not a benefit to quality of life with ASV" comment from RESMED?

Contact prior patients with symptomatic heart failure whom you have treated with ASV since 2005 and advise them of the risks. You should strongly consider recommending that they stop ASV treatment. Which alternative treatments for central sleep apnea to recommend, if any, will need to be individualized. The control arm of the SERVE-HF study was best medical management without management of concurrent central sleep apnea. Representatives at ResMed have indicated that in their preliminary assessment of the data, there was not quality of life benefit to therapy with ASV. Together, these indicate that at the very least, patients should ensure they are receiving best evidence-based care for their heart failure. Other evidence-based therapies to consider for CSA might include CPAP or oxygen, but long-term outcome studies for these therapies are not conclusive either. (http://aasmnet.org/articles.aspx?id=5562)

Thanks!

The advisory from ResMed is CHF specific. CHF can cause periodic breathing and Cheyne Stokes Breathing which may be a beneficial response to the CHF symptoms. Central Apnea and Mixed Apneas without CHF can be treated with great success. I went from a PSG AHI of 44 to an AHI of near ar at 0 on my ASV machine.

Rich

[ricknfli]

Thanks for your reply Richb!

There is hope!