Anticyclic modulated ventilation versus continuous positive airway pressure in patients with coexisting obstructive sleep apnea and Cheyne–Stokes respiration: a randomized crossover trial

BackgroundAlthough coexisting obstructive sleep apnea (OSA) and Cheyne–Stokes respiration (CSR) occur frequently in patients with heart diseases, optimal treatment remains unclear. Positive airway pressure (PAP) effectively treats OSA and adaptive servo-ventilation (ASV) has been shown to improve CSR. We compared a new treatment algorithm combining automatic continuous positive airway pressure (APAP) and ASV (anticyclic modulated ventilation, ACMV) versus continuous positive airway pressure (CPAP).MethodsThirty-nine patients (35 male, four female; aged 65.5 ± 9.7 years; body mass index, 31.0 ± 5.9 kg/m2) with underlying heart disease and coexisting OSA and CSR were enrolled. After diagnostic polysomnography (PSG) and CPAP titration, patients were randomized either to CPAP or to ACMV for four weeks of treatment in a crossover design.ResultsTotal apnea–hypopnea index (AHI) was 49.0 ± 18.8/h at baseline, 12.3 ± 14.6/h with CPAP (P < 0.001 vs baseline), and 3.7 ± 5.6/h with ACMV (P < 0.001 vs baseline and vs CPAP). Obstructive AHI was 20.7 ± 14.4/h at baseline, 5.1 ± 9.3/h with CPAP (P < 0.001 vs baseline), and 0.4 ± 0.4/h with ACMV (P < 0.001 vs baseline and vs CPAP). Central AHI was 28.3 ± 13.4/h at baseline, 7.2 ± 9.7/h with CPAP (P < 0.001 vs baseline) and 3.3 ± 5.4/h with ACMV (P < 0.001 vs baseline and vs CPAP). Ejection fraction was increased significantly (from 38.6 ± 15.6 to 44.4 ± 12.2%) only with ACMV. Subjective sleepiness significantly improved only with CPAP whereas objective sleep quality and treatment adherence were not different between both treatment modalities.ConclusionACMV is an effective treatment option in patients with coexisting OSA and CSR. It is superior to CPAP in reducing total AHI as well as obstructive and central AHI.