Adaptive servo-ventilation for central sleep apnea: usage and effect on sleep and symptoms–a multicenter registry study

RATIONALE: Evidence on adherence to adaptive servo-ventilation (ASV), sleep architecture, and patient-reported outcomes in patients with central sleep apnea (CSA) in routine clinical practice is limited. OBJECTIVE: The primary objective was to assess adherence to ASV in a real-world population with CSA; secondary objectives were to evaluate longitudinal changes in sleep fragmentation, polysomnographic sleep architecture, and patient-reported outcomes. METHODS: The multicenter, prospective, observational AutoSV Registry (NCT03421704, 2018-2023) enrolled adult patients with CSA, who were prescribed ASV (Philips DreamStation BiPAP auto SV). The follow-up period was up to 24 months. Adherence data were collected via telemonitoring software (Philips EncoreAnywhere™). Polysomnography (PSG) was performed at diagnosis, during ineffective continuous positive airway pressure with residual CSA (CPAPrCSA) and on ASV. Sleepiness (Epworth Sleepiness Scale, ESS) and subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) were measured. RESULTS: Of the 125 enrolled patients, 66% had impaired subjective sleep quality (PSQI>5) and 33% were sleepy (ESS>10). Adherence to ASV therapy was at least 4 hours/night in 67% of patients. Median adherence was 5.3 (3.1; 6.7) hours/day (n = 103, median (IQR) follow-up 16 months). Sleep fragmentation was reduced during ASV, with decreased sleep stage N1 and increased sleep stage N3 and rapid eye movement sleep compared with diagnostic PSG and CPAPrCSA therapy. The global PSQI (mean [95%CI]) score improved by -1.7 (-2.9; -0.6) (p < 0.001; n = 55), and the ESS score (mean [95%CI]) improved by -1.9 (-3.2; -0.6) (p < 0.001; n = 57) from baseline to 24 months. CONCLUSIONS: ASV therapy in a sleep-clinic population with CPAPrCSA was associated with high adherence, possibly reflecting clinically meaningful benefits, including reduced sleep fragmentation, improved objective and subjective sleep quality, and reduced sleepiness.