If Cost Were No Object Should Everyone Use an ASV?

[Perchance2Dream]

Just what the title says. Given that CPAP has a single pressure that you have to push against, minus the EPR pressure. And bilevel has two pressures, but your breath is adjusting nonlinearly as you fill the balloons of your lungs, would an ASV type therapy be the most tolerable? Would it be the best at emulating natural healthy breathing?

[srlevine1]

ASV, regardless of the cost, is contraindicated for certain types of conditions and is not a universal panacea. 

Adaptive Support Ventilation

One of the main contraindications for the use of adaptive support ventilation (ASV) is in obese patients, post-major cardiothoracic surgery low on functional residual capacity (FRC) who are prone to derecruitment. Those with restrictive lung disease tend to be provided with low tidal volumes.

ResMed provides updated contraindication for ASV therapy

Earlier this week ResMed notified the American Academy of Sleep Medicine that it has updated the description of the contraindicated population originally described in the Field Safety Notice issued May 13, 2015, to address the safety concern identified during the preliminary primary data analysis from the SERVE-HF clinical trial of adaptive servo-ventilation (ASV) therapy for central sleep apnea. ResMed announced that it is updating and narrowing the contraindication of ASV therapy to patients with symptomatic, chronic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea.

According to ResMed, the announcement was based on consultation with various regulatory authorities and expert opinion expressed by professional medical societies. Including moderate to severe predominant central sleep apnea as part of the contraindication aligns it with the inclusion criteria from the SERVE-HF trial. Noting that it is updating the User Guides for ASV devices, ResMed advised that the updated, narrower contraindication is considered the most appropriate identification of at-risk patients.

[Sleeprider]

ASV is for central and mixed apnea. In my experience, individuals using ASV for treatment of plain obstructive apnea or "upper airway resistance" fair relatively poorly with the adaptive pressures and backup rate of ASV as compared to the Vauto or BiPAP auto.

[elmo582]

Would my ResMed AirCurve 10 VAuto be an ASV?
If so, that would explain why at times the pressure and flow seems to modulate at times.

[Sleeprider]

Elmo, the Vauto used fixed pressure and relies on spontaneous effort to trigger IPAP. It cannot act as a respiratory assist device with a backup rate or enough pressure support to cause a breath. I think you might benefit from reading the Resmed Sleep Lab Titration Guide. https://document.resmed.com/en-us/docume...er_eng.pdf It accurately describes the different machines available including the Vauto on page 24, and the ASV on page 28. Also don't hesitate to request a copy of the Resmed Aircurve 10 Vauto clinical guide from the forum. Follow the link for Setup Manuals at the top of the page.

[Zoltyzolt]

Hi, first of all thanks for responding to the forum we all really appreciate it.

I have been using a asv for a while for my uars and I’m noticing while a lot better than previously my sleep is not where it needs to be. (I have a doctor prescribed vauto coming in anyways)

Could you explain based on your experience why you think asv isn’t the best for uars?

[hopeforusall]

Hello.
Board member 'srlevine1' posted a clip from https://aasm.org/resmed-provides-updated...v-therapy/
It states:
...contraindication of ASV therapy to patients with...and moderate to severe predominant central sleep apnea.
Perhaps I am confused, but is this a game changer and a recommendation AGAINST ASV for those with moderate to severe central sleep apnea?

[srlevine1]

Hello.
Board member 'srlevine1' posted a clip from https://aasm.org/resmed-provides-updated...v-therapy/
It states:
...contraindication of ASV therapy to patients with...and moderate to severe predominant central sleep apnea.
Perhaps I am confused, but is this a game changer and a recommendation AGAINST ASV for those with moderate to severe central sleep apnea?

No, it is a warning that ASV as a therapy for PATIENTS WITH moderate to severe predominant central sleep apnea MAY BE (or is) contraindicated for certain types of patients, notably those with cardiac issues such as congestive heart failure,  where the ejection fraction, the  percentage of the total amount of blood in your heart that is pumped out with each heartbeat, is lower than a specific value. 

Your doctor is the best judge of the adequacy of an ASV device to provide therapy for your particular condition.