Cantero Chloé, Adler Dan, Pasquina Patrick, Uldry Christophe, Egger Bernard, Prella Maura, Younossian Alain Bigin, Poncet Antoine, Soccal-Gasche Paola, Pepin Jean-Louis, Janssens Jean-Paul
Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Front Med (Lausanne). 2020 Apr 3;7:105. doi: 10.3389/fmed.2020.00105. eCollection 2020.
Use of adaptive servo-ventilation (ASV) has been questioned in patients with central sleep apnea (CSA) and chronic heart failure (CHF). This study aims to detail the present use of ASV in clinical practice. Descriptive, cross-sectional, multicentric study of patients undergoing long term (≥3 months) ASV in the Cantons of Geneva or Vaud (1,288,378 inhabitants) followed by public or private hospitals, private practitioners and/or home care providers. Patients included (458) were mostly male (392; 85.6%), overweight [BMI (median, IQR): 29 kg/m (26; 33)], comorbid, with a median age of 71 years (59-77); 84% had been treated by CPAP before starting ASV. Indications for ASV were: emergent sleep apnea (ESA; 337; 73.6%), central sleep apnea (CSA; 108; 23.6%), obstructive sleep apnea (7; 1.5%), and overlap syndrome (6; 1.3%). Origin of CSA was cardiac ( = 30), neurological ( = 26), idiopathic ( = 28), or drug-related ( = 22). Among CSA cases, 60 (56%) patients had an echocardiography within the preceding 12 months; median left ventricular ejection fraction (LVEF) was 62.5% (54-65); 11 (18%) had a LVEF ≤45%. Average daily use of ASV was [mean (SD)] 368 (140) min; 13% used their device <3:30 h. Based on ventilator software, apnea-hypopnea index was normalized in 94% of subjects with data available (94% of 428). Use of ASV has evolved from its original indication (CSA in CHF) to a heterogeneous predominantly male, aged, comorbid, and overweight population with mainly ESA or CSA. CSA in CHF represented only 6.5% of this population. Compliance and correction of respiratory events were satisfactory. www.ClinicalTrials.gov, identifier: NCT04054570.
对于患有中枢性睡眠呼吸暂停（CSA）和慢性心力衰竭（CHF）的患者，自适应伺服通气（ASV）的使用一直存在争议。本研究旨在详细阐述ASV在临床实践中的当前使用情况。对在日内瓦州或沃州（1,288,378名居民）接受长期（≥3个月）ASV治疗的患者进行描述性、横断面、多中心研究，这些患者由公立或私立医院、私人执业医生和/或家庭护理提供者随访。纳入的患者（458例）大多为男性（392例；85.6%），超重[体重指数（中位数，四分位间距）：29 kg/m²（26；33）]，患有多种合并症，中位年龄为71岁（59 - 77岁）；84%的患者在开始使用ASV之前接受过持续气道正压通气（CPAP）治疗。ASV的适应证为：紧急睡眠呼吸暂停（ESA；337例；73.6%）、中枢性睡眠呼吸暂停（CSA；108例；23.6%）、阻塞性睡眠呼吸暂停（7例；1.5%）和重叠综合征（6例；1.3%）。CSA的病因包括心脏性（ = 30）、神经性（ = 26）、特发性（ = 28）或药物相关性（ = 22）。在CSA病例中，60例（56%）患者在过去12个月内进行了超声心动图检查；左心室射血分数（LVEF）中位数为62.5%（54 - 65）；11例（18%）患者的LVEF≤45%。ASV每日平均使用时间为[均值（标准差）]368（140）分钟；13%的患者使用设备时间<3.5小时。根据呼吸机软件，在有可用数据的受试者中，94%（428例中的94%）的呼吸暂停低通气指数恢复正常。ASV的使用已从其最初的适应证（CHF中的CSA）演变为以ESA或CSA为主的异质性人群，主要为男性、老年人、患有合并症且超重。CHF中的CSA仅占该人群的6.5%。呼吸事件的依从性和纠正情况令人满意。ClinicalTrials.gov网站，标识符：NCT04054570。
