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== Justifying ASV ==
ASV or [[Adaptive servo-ventilation (ASV)]]
For Complex Sleep Apnea
* Titrate to minimize OSA (obstructive AHI less than 5 per hour)
* Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)
* Document the presence of at least one of the following symptoms:
** Sleepiness,
** Awakening short of breath,
** Difficulty initiating or maintaining sleep,
** frequent awakenings, or
** nonrestorative sleep,
** Snoring,
** Witnessed apneas
'''Central sleep apnea (CSA)''' is defined as:
# An apnea-hypopnea index (AHI) greater than 5, and
# The sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas, and
# A central apnea-central hypopnea index (CAHI) is greater than or equal to 5 per hour, and
# The presence of at least one of the following: Sleepiness, Awakening short of breath, Difficulty initiating or maintaining sleep, frequent awakenings, or nonrestorative sleep, Snoring, Witnessed apneas
# There is no evidence of daytime or nocturnal hypoventilation
'''Complex sleep apnea (CompSA)''' is a form of central apnea specifically identified by all of the following:
# With use of a positive airway pressure device without a backup rate (E0601 (CPAP) or E0470 BiLevel/BiPAP wo Backup), the polysomnogram (PSG) shows a pattern of apneas and hypopneas that demonstrates the persistence or emergence of central apneas or central hypopneas upon exposure to CPAP (E0601) or a bi-level device without backup rate (E0470) device when titrated to the point where obstructive events have been effectively treated (obstructive AHI less than 5 per hour).
# '''After resolution of the obstructive events''', the sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas; and
# '''After resolution of the obstructive events''', a central apnea-central hypopnea index (CAHI) greater than or equal to 5 per hour.
[[Central sleep apnea (CSA)|Central Sleep Apnea (CSA)]] is the cessation of respiratory effort result in a lack of respiratory movements. During sleep, your breathing is disrupted regularly because of how your brain functions, your brain simply doesn't tell your body to breathe, and therefore you don't try to breathe.
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