Adaptive Servo-Ventilation Therapy in a Case Series of Patients with Co-morbid Insomnia and Sleep Apnea

Adaptive Servo-Ventilation Therapy in a Case Series of Patients with Co-morbid Insomnia and Sleep Apnea

Study objectives: The study measured the effects and use of adaptive servo-ventilation (ASV) therapy among insomnia patients with co-morbid sleep-disordered breathing (complex insomnia) who failed standard positive airway pressure (PAP) therapy. Methods: A chart review was conducted on 56 consecutive patients with complex insomnia and self-reported anxiety or psychiatric distress to compare outcomes from their use of standard PAP therapy with their use of ASV. Measurements included polysomnographic changes in breathing events, sleep stages, sleep continuity markers, and adherence data downloads. Results: On standard PAP titrations, expiratory pressure intolerance and central apneas were highly prevalent, yielding a diagnosis of or subthreshold criteria for complex sleep apnea, after which patients received ASV therapy. Compared to standard PAP, ASV significantly improved objective breathing event indices. ASV also was associated with increased sleep efficiency, REM% sleep, and REM sleep consolidation as well as decreased awakenings, arousals, and time awake during the night. Among 39 of 43 current ASV users, adherence was significantly greater for nightly use and hours per night compared to prior use of standard PAP. Conclusions: Fifty-six complex insomnia patients failed standard PAP therapy and developed complex sleep apnea. ASV therapy was associated with improved sleep quality and increased device usage in this select sample.