Medical College of Georgia (Georgia Health Sciences University), Augusta, GA 30912, USA.
J Clin Sleep Med. 2012 Feb 15;8(1):103-6. doi: 10.5664/jcsm.1674.
An 80-year-old man with severe central sleep apnea due to Cheyne-Stokes breathing (AHI 41.2) caused by severe cardiac failure underwent a trial of adaptive servo-ventilation (ASV) by full face mask after failure of a fixed CPAP trial. Recommended procedure was closely followed and the ASV device activated normally during central apneas. Initial settings were EEP 5, PSmin 3, PSmax 15 on room air. The device did not capture the thorax or abdomen, as shown by lack of change in respiratory inductive plethysmography, despite expected mask pressure waveforms. Snoring was also detected during apneas with device activation. Desaturation continued, followed by arousals during hyperpnea. On the device, the patient clearly slept for 1-3 epochs during the central apneas only to awaken during hyperpnea. We hypothesize that the failure to capture may have resulted from "reverse" obstructive apnea, possibly due to glottic closure during ASV activation. We suggest that earlier manual adjustments to ASV in cases such as ours, prior to waiting for the recommended 20 to 40 min of sleep, may be appropriate in selected patients. We also consider additional interventions that may increase the likelihood of a successful trial.
一位 80 岁男性因严重心力衰竭导致中枢性睡眠呼吸暂停（呼吸暂停低通气指数为 41.2），行 Cheyne-Stokes 呼吸，使用全脸面罩行适应性伺服通气（ASV）试验失败后，又行持续气道正压通气（CPAP）试验失败。遵循推荐的操作流程，在中枢性呼吸暂停期间，ASV 设备正常激活。初始设置为在空气环境下，呼气末正压为 5cmH2O，最小压力为 3cmH2O，最大压力为 15cmH2O。设备未检测到胸廓或腹部的运动，尽管预期的面罩压力波形发生了变化，但呼吸感应容积描记法仍无变化。在设备激活期间，呼吸暂停时也检测到了打鼾。持续出现低氧血症，随后在过度通气时出现觉醒。在设备上，患者在中枢性呼吸暂停期间仅清楚地睡了 1-3 个时期，然后在过度通气时醒来。我们假设未检测到呼吸暂停可能是由于“反向”阻塞性呼吸暂停所致，这可能是由于在 ASV 激活期间声门关闭。我们建议，在等待推荐的 20-40 分钟睡眠之前，对于我们这种情况的患者，可提前手动调整 ASV，这可能适合于特定患者。我们还考虑了其他可能增加试验成功可能性的干预措施。
