(07-14-2020, 08:38 AM)Sleeprider Wrote: An older version of ASV was implicate in excess death rate in the SERVE-HF study published in 2015, based on a cohort of congestive heart failure patients with Cheyne-Stokes respiration.  The study identified the excess death rate among severely impaired CHF patients without identifying a specific cause, and recommended out of caution that ASV not be used in CHF patients with left ventricular ejection fraction less than 45%.  There are several techniques for determining LVEF %, most commonly echocardiogram (ECG or EKG).

A newer study, ADVENT-HF is still in progress, but has reported since 2018 that there is no excess risk associated with ASV, and cites the flaws in the SERVE-HF study. The main difference is that newer ASV is capable of auto-adjusting EPAP, and the study cohort has been properly titrated and monitored for use of the devices.  Many individuals in the original study had very little actual use of the ASV machines.  There is a fair amount of information online about these studies and the problems in the SERVE-HF study design.  With the warning from the SERVE-HF study, it has been routine to screen for LVEF <45% since 2015.

(07-14-2020, 08:53 AM)Sleeprider Wrote: Yes of course. The forum has assisted literally hundreds of members to optimize ASV, and nearly without exception, we can improve results compared to a laboratory titration and the doctor's settings which are nearly always based on fixed ASV.  We follow the principles in the Resmed ASV Titration Protocol below, but sometimes settings are a blend of the art and science.  With all the members here that use ASV you will have an abundance of help and suggestions.  I also included a copy of the recommended cardio screening procedure for ASV.  Note, if you are reasonably certain you do not have heart failure, you can go straight to ASV.

(07-14-2020, 09:23 AM)Sleeprider Wrote: If you are currently comfortable, and are not concerned with the current level of AHI, then you don't need ASV.  We can work with lower EPR or just allow more time to see if events diminish spontaneously.   I think your charts look worse than they really are, this is mostly because you are not shrinking the vertical scale to show the view of events, flow rate, pressure, flow limitation and leaks that we would rather see.  Instead we see huge charts of events, flow and pressure.   Anyway, I agree, you are at best borderline to need ASV, and this can still self-resolve using your Aircurve 10 Vauto.