[Treatment] The ASV conundrum [ResMed study]

[zonk]

deja vu
http://www.apneaboard.com/forums/Thread-...SV-devices

[bwexler]

This may be a timely discussion for me. I will be getting my routine stress echo in a couple weeks.
My primary wasn't sure why I thought it was appropriate.

I don't plan on giving up my ASV any time soon.

[palerider]

I don't see a link to this, please forgive me if it was posted and I missed it, but it was brought to my attention by a sleep medicine physician, I believe it's relevant:

http://www.sciencedirect.com/science/art...9215003505

[Asjb]

In my opinion the full story is not yet available, further trials are hopefully ongoing, so there are no black and white answers to this at the moment.

There is also some useful info in this 02/2016 article:
http://jtd.amegroups.com/article/view/6357/6225

My personal interpretation, based on the current state of knowledge:

ASV will be fine if you have no heart disease.

There is inadequate data available for those people with heart failure but a normal ejection fraction i.e. HFNEF (implying a diastolic dysfunction not a systolic dysfunction)

According to the SERVE-HF trial results, starting ASV from new will not be contra-indicated if you also have heart failure but your LVEF is better than 45%.

Starting ASV while having severe cardiac failure (LVEF of less than 45%): severe heart failure is a condition with many symptoms, reduced quality of life, and a poor prognosis. There seems no doubt that ASV therapy noticeably improves symptoms and quality of life in many people with severe heart failure. This now, since SERVE-HF, has to be balanced against this apparent new risk of sudden cardiac death. For me, that should be a personal decision, informed by talking with a doctor you trust.

Continuing ASV while also having worsening heart failure: is also I think a discussion to be had between the patient and their cardiologist. After I spent most of a year 'failing' CPAP/APAP and with new, treatment induced, central apnoeas, I wrote to the doctor who finally prescribed my ASV: <My LVEF was last known to be normal, but to be honest I think I would actually prefer the risk of sudden cardiac death than to continue with inadequate xPAP treatment and all the symptoms and risks this is causing>. I still stand by that (I await my next echocardiogram, in July).

Agree with Vsheline - repeating an echocardiogram if you or your doctor do not believe the results - a very good idea in my opinion.

If you have non-severe cardiac failure, or even just significant coronary artery disease, and are using ASV, an annual echocardiogram seems a sensible idea to me too.
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All my opinions are only as an xPAP user trying to help another xPAP user.
No suggestions I may make should be taken as professional advice.
If you have medical concerns please consult a doctor

My current pressures: Auto-ASV. EPAP 10-13. PS 3-10

[Asjb]

Forgot to mention - this is a useful 'position statement' on exactly this issue, from the American Thoracic Society, written for patients:

https://www.thoracic.org/patients/patien...es/asv.pdf