ST vs ASV - studies about risk

[kiwii]

What are the strategic points to make in arguing the case of ASV instead of ST?

Sleeprider, Dave did not actually use an ST before the ASV. Can you (or anyone!) think of another case/thread that involves someone using the ST? Hopefully someone that used the ST and switched to the ASV.

[ajack]

If you have reduced EF below 45%, there are no arguing points. It is too risky to go on ASV and medical consensus will exclude you from it. The second trial may well duplicate the first. Did you watch the videos, the experts on ASV are compelling.

[Sleeprider]

Several. Josephfdco when he was issued the ST http://www.apneaboard.com/forums/Thread-...ilating-me
Before the machine http://www.apneaboard.com/forums/Thread-...ble-nights His story never worked out and it's a real shame.

zzzZorro http://www.apneaboard.com/forums/Thread-...ve-10-ST-A
He has insufficient LVEF% for ASV and the ST experiment failed. He is back to CPAP.

There have been a few others, like rbookman, but we never heard back after he started.

[zzzZorro]

If you have reduced EF below 45%, there are no arguing points. It is too risky to go on ASV and medical consensus will exclude you from it. The second trial may well duplicate the first. Did you watch the videos, the experts on ASV are compelling.

I was going to keep my mouth shut but I will make this one comment.  I have run the gauntlet on this issue.  AJACK and I have only partially agreed on the SERVE-HF studies.  The BOLD we agree on.  The Italics we do not.  The LVEF<45% ASV exclusion is currently established as the rule in the medical profession and despite all my trying to be an exception, it fell on deaf ears. 

FWIW; My sleep Doc agreed with me that the ruling was on shaky ground, but that he had very learned colleges who strongly believed in it.  He also agreed that the ST could well prove as morbid (with reduced LVEF) as the ASV in that the focus was on the ASV and not ST.  He also believed if a patient did not have a low 02 problem he was against using 02 as "it was like any other drug- it had consequences".  The new ADVENT-HF study which will probably not be public for another year or more could well reverse SERVE-HF.  Till then it is most probably a waste of time trying to buck the program. The best I could do was a ST-A thinking it was worth a try as breath support for C/As and mixed apnea problems.  It didn't work for me.  With it I got up to AHI-59.27.

The ST-A only lists U/As and Hs.  It does not differentiate U/As from C/As and O/As. I did not find that helpful.  As I have no lung problems iVAPS was of little use to me and I ran it in CPAP-mode (down to AHI-4.45) until I got the VPAP back (which is being used in the CPAP-mode also).  ASV will most certainly prove to be a brick wall for LVEF<45% at this time.. 

If not, power to you

[Spy Car]

If you have reduced EF below 45%, there are no arguing points. It is too risky to go on ASV and medical consensus will exclude you from it. The second trial may well duplicate the first. Did you watch the videos, the experts on ASV are compelling.

I watched the video and became more (rather than less) convinced of the study's flaws.

Multiple members of the committee mentioned the results were contrary to expectations, other studies, meta-analyses, and clinical experiences (and therefore "surprising"). There was no identified mechanism. And the compliance was totally inadequate, as one panelist admitted.

And the virtues of ASV were clear in all other patient groups.

The panelists at several points seem to acknowledge that their study had received fierce criticism of the methods and conclusions. 

We need better science than this deeply flawed study, in my estimation. 

Bill

[kiwii]

If you have reduced EF below 45%, there are no arguing points. It is too risky to go on ASV and medical consensus will exclude you from it. The second trial may well duplicate the first. Did you watch the videos, the experts on ASV are compelling.

I don't have reduced EF. Yes, I watched the videos... but my cognitive ability is too reduced at the moment to understand most of it.

[kiwii]

At this point, my question is:

Between the ST and ASV, which one is going to provide the most comfortable way for me to receive backup?

What can I present to the sleep doctor, who is aiming for ST, to change to ASV (assuming that is what I'd like)?

I do have an O2 problem. My AHI is pretty good.

I sometimes (rarely) wakeup realizing that I am not inhaling. Consciously trying to initiate an inhale is like there is a disconnect between my brain and my diaphragm, and nothing happens, so I turn on my side and everything is fine. If it is sleep paralysis (as suggested by the previous sleep doctor), then it is isolated to my diaphragm because I do not have any sensation of paralysis whatsoever and can move around easily. What I cannot do is initiate inhalation by willing it to happen. There is no sensation of anything on my chest; no sensation of suffocation - it feels like my chest has collapsed in on itself; like I've exhaled so completely that it has gone below the point it would normally go to (I am physically unable to exhale that completely when awake). [edit: and if I *can* get it up to a certain point, then inhalation kicks in and it's all good]

---

Thanks for those links, Sleeprider!

[ajack]

ASV generally won't fix o2, it is for brain signals going wrong and forgetting to breathe. It sounds like you have more of a copd issue. Bilevel/bipap, S, ST or a/i VAPS would probably be the path. With supplemental o2 if needed.

[kiwii]

ASV generally won't fix o2, it is for brain signals going wrong and forgetting to breathe. It sounds like you have more of a copd issue. Bilevel/bipap, S, ST or a/i VAPS would probably be the path. With supplemental o2 if needed.

Doesn't forgetting to breath sound like what I am doing (not inhaling?)

Sorry if I am misunderstanding you. I'm finding it very difficult to track what people are saying.

[kiwii]

I can barely stand to read the first thread - there is no way in hell that I am going to endure a strangling sensation. The last thing I need is to get triggered in a way that causes me to stop using xPAP.