Individuals with obstructive sleep apnea who develop central sleep apnea (CSA) are more compliant with their therapy after switching from continuous positive airway pressure (CPAP) therapy to adaptive servo-ventilation (ASV) therapy, according to a broad survey of sleep patients patients with treatment-emergent CSA that was commissioned by sleep equipment maker ResMed.
The study analyzed anonymous, aggregated data from the devices of 198,890 remotely monitored patients in the United States who were receiving positive airway pressure therapy for their sleep apnea. Those patients with treatment-emergent CSA that switched from CPAP to ASV used their therapy longer and had significantly fewer apneas during sleep.
Specifically, prior to switching. 62.7 percent of those patients were compliant on thier CPAP. After switching to an ASV, their compliance improved so that 76.6 percent were adhering to their therapy.
“Achieving compliance through proper therapy usage is a well-recognized clinical goal in sleep apnea management, and one that is often hard to achieve, particularly in difficult-to-treat patients who may have untreated central sleep apnea,” said Carlos Nunez, M.D., ResMed’s Chief Medical Officer. “These findings underscore the importance of continuously monitoring central sleep apnea and rethinking the conventional wisdom on therapeutic options based on each patient’s disease severity.”
The study used the U.S. Medicare definition of compliance, which is that device usage lasts for more than four hours per night on 70 percent of nights during a consecutive 30-day period, anytime during the first three months of initial use.
In the group that switched from CPAP to ASV, patients beginning on CPAP had the lowest initial compliance rate at 62.7 percent, but improved to 76.6 percent after switching to ASV. The low initial compliance seen in the group that switched is possibly due to untreated CSA, based on their overall higher Apnea-Hypopnea Index (AHI) during week one of therapy compared to the CPAP-only group. The 90-day compliance rates seen for the CPAP-only and ASV-only groups were 73.8 percent and 73.2 percent, respectively. In the Switch group, average residual AHI also decreased significantly (reduction from 17.2±0.9/h to 4.4±0.3/h) after the switch, indicating that ASV reduced both obstructive and central events.
Mean device usage at 90 days was similar for ASV in the Switch group with a rate of 5.73 hours per day, compared to 5.27 and 5.31 for the CPAP-only and ASV-only groups, respectively.
The study results were presented in an abstract at The European Respiratory Society and European Society of Sleep Research 2017 Sleep and Breathing conference in Marseilles, France. The study’s author group include:
- Jean-Louis Pépin from Institut National de la Santé et de la Recherche Médicale (INSERM), U 1042, HP2 Laboratory (Hypoxia: Pathophysiology), Grenoble Alpes University, Grenoble, France.
- Peter Cistulli from Charles Perkins Centre, University of Sydney, and Royal North Shore Hospital, Sydney, Australia.
- Atul Malhotra from University of California San Diego, La Jolla, Calif.