Bi-Level, S, ST, ASV??

[jtech1]

Can someone point me to a good description of the differences between these devices?  I have been lucky enough to get proper treatment myself with my Dreamstation Auto... but a family member is being trialed with Bi-PAP... not sure which flavor.  They have heart failure (low LVEF), and I am trying to understand what the variations of the devices above do differently, and which ones are avoided for people with heart failure.  I did not find any posts that go over the differences via search... if you can point me to any I missed that would be great!  Or if you have HF and use one of these, I'd really appreciate your input.  Thank you!

[Gideon]

See this Wiki article, a table near the top has most of the info that you are looking for.

http://www.apneaboard.com/wiki/index.php...AP_-_BIPAP

To the best of my knowledge LVEF (<45%) only applies to the ASV and that is expected to be changed next year.

[DeepBreathing]

There is a summary of all the current Resmed devices here: https://www.resmed.com/us/en/healthcare-...entilation Click on the image of each machine to get some more detailed information. Each of the machines is optimised to treat a particular condition. As to which device is suitable for your friend, that depends very much on their underlying condition - is it just apnea (obstructive and/or central), obesity hypoventilation, airway restriction (UARS) or something else?

The issue of congestive heart failure applies to ASV machines which are used to treat central apnea and Cheyne Stokes respiration. A large trial by Resmed (SERVE-HF) was abandoned after a particular cohort of patients were suffering a higher death rate than the control group. At present ASV is contraindicated if you have congestive heart failure with a left ventricular ejection fraction below 45. There is a concise summary of the findings here: https://www.resmed.com/epn/en/healthcare...sults.html There are now follow-up trials to quantify risks and isolate the mechanism which showed up in SERVE-HF.

[WillSleep]

Can someone point me to a good description of the differences between these devices?  I have been lucky enough to get proper treatment myself with my Dreamstation Auto... but a family member is being trialed with Bi-PAP... not sure which flavor.  They have heart failure (low LVEF), and I am trying to understand what the variations of the devices above do differently, and which ones are avoided for people with heart failure.  I did not find any posts that go over the differences via search... if you can point me to any I missed that would be great!  Or if you have HF and use one of these, I'd really appreciate your input.  Thank you!

Hi jetech1, 

I have not yet seen the one document that ties it all together.  I will be watching the thread because I would love to set it.  

For sure the ResMed Aircurve 10 ASV is most often contraindicated (Do Not Use) for low LVEF (Update:  Actually refer to the link posted by DeepBreathing). 

I am seen many research papers and results of clinical trials posted on PubMed with the use and results of xPAP for only one medical condition at a time.  Let me know if you would like me to post links of example queries.  

Attached is the best summary I have seen from Phillips on Roles and Features of each of their xPAP machines.  I was disappointed to see this good doc is actually pretty soft on HF roles.   
     

I have not seen a similar current good detailed one-page summary from ResMed, and I await with bated breath ... 

WillSleep

[jtech1]

Thanks!  I will read over all that.  I am trying to get some details of the sleep study to see why they are looking at BiPap.

From the links it looks like ResMed has a few BiPap flavors... VAuto, S, ST, ST-A.  Philips has only one BiPap Auto.  Does the Philips model have the S and T features of the different ResMed models (I don't see any reference to that)... or is ResMed the only one that makes BiPAP with the S and T features?

[WillSleep]

 Does the Philips model have the S and T features of the different ResMed models (I don't see any reference to that)... or is ResMed the only one that makes BiPAP with the S and T features?

The Phillips "BiPAP S/T" model is in the last column of the one-page marketing doc I attached above, model DSX1060 (xx..).

Phillips intermingled both the AVAPS and BiPAP S/T into the last column 

When your looking to sort that out exactly feel free to ask specific questions 
... and also the Phillips Tritration Guide does a reasonable job of clarifying what is available on each machine.

WillSleep

[Sleeprider]

In treating congestive heart failure patients with low left ventricular ejection fraction, you will very frequently hear the SERVE-HF study cited https://www.nejm.org/doi/full/10.1056/NEJMoa1506459 . This was a study that was published in 2015, and involved a large cohort of CHF patients, and identified an increased risk of cardiac death with use of ASV. There were significant problems with this study, especially the use of older fixed pressure ASV technology and a patient cohort that was neither titrated nor consistently compliant with the device use.

A new study is still in progress, ADVENT-HF https://www.mdedge.com/chestphysician/ar...-no-safety that shows promising early results and no increased risk for CHF patients with ASV use. The advantages of ASV in treating Cheyne-Stokes Resopiration, central apnea and other common complications of heart failure are real, and of course the prognosis of these patients is not good. I hope the new study will bring some balance to the discussion, and allow these patients to receive effective therapeutic relief and bring ASV back to their treatment.

[Sleeprider]

 Does the Philips model have the S and T features of the different ResMed models (I don't see any reference to that)... or is ResMed the only one that makes BiPAP with the S and T features?

The Phillips "BiPAP S/T" model is in the last column of the one-page marketing doc I attached above, model DSX1060 (xx..).

Phillips intermingled both the AVAPS and BiPAP S/T into the last column 

When your looking to sort that out exactly feel free to ask specific questions 
... and also the Phillips Tritration Guide does a reasonable job of clarifying what is available on each machine.

WillSleep

WillSleep, I find the Resmed Titration Guide to be a much better explanation of the technologies, and intended uses for the various machines, including advanced bilevels.  I have relied on this document in may replies on the forum and find the Philips too ambiguous to be useful for many people.
https://www.resmed.com/us/dam/documents/...er_eng.pdf

[WillSleep]

WillSleep, I find the Resmed Titration Guide to be a much better explanation of the technologies, and intended uses for the various machines, including advanced bilevels.  I have relied on this document in may replies on the forum and find the Philips too ambiguous to be useful for many people.
https://www.resmed.com/us/dam/documents/...er_eng.pdf

Sleeprider.  I completely agree with you! 

I was answering jtech's question specifically about Phillps machines ... only referencing the Phillips guide as a tool avialable to jetch to better help sort out exactly which features are available on which Phillips-Respironics machines

WillSleep

[SarcasticDave94]

Everything about ASV and contraindications posted on this thread are accurate. I do hope they get that other test out to refute the prior. I know caution is required with medical issues such as this so I do understand that. Even so, as I've gone through these ASV hoops myself, that LVEF of 45% would likely be quite evident in poor health as is.