Adaptive Servo Ventilation (ASV)

Indications


Contraindications

  • Systolic Congestive Heart Failure (CHF) with Central Sleep Apnea (CSA) [MEDLINE]: adaptive servo ventilation increases mortality in this patient population

Technique

Adaptive Servo Ventilation is Form of Pressure-Preset Closed-Loop Mechanical Ventilation (Which Can Be Volume or Flow-Cycled)

  • ASV is a Form of of Bi-Level Positive Airway Pressure Which Provides Variable Pressure Support (Via a Servo Mechanism-Based Assessment of Patient’s Respiratory Output): ASV can, therefore, treat both obstructive and central sleep apneas
    • When There are Hypopneas: ASV increases the pressure support (difference between expiratory PAP and inspiratory PAP)
    • When There are Hyperpneas: ASV decreases the pressure support (difference between expiratory PAP and inspiratory PAP)
    • When There are Central Sleep Apneas: ASV utilizes a backup rate and the EPAP maintains airway patency

Device Manufacturers

  • ResMed ASV (AutoSet CS, AutoSet CS2, VPAP Adapt, or VPAP AdaptSV)
  • Respironics ASV (BiPAP autoSV or HEART PAP)

References

  • A prospective polysomnographic study on the evolution of complex sleep apnoea. Eur Respir J 2011;38(2):329-337 [MEDLINE]
  • Therapy for sleep hypoventilation and central apnea syndromes. Curr Treat Options Neurol 2012;14(5):427-437 [MEDLINE]
  • Air leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med 2013;9(11):1187-1191 [MEDLINE]
  • Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med 2015;373:1095-1105 [MEDLINE]