Adaptive Servoventilation as Treatment for Central Sleep Apnea Due to High-Altitude Periodic Breathing in Nonacclimatized Healthy Individuals

Adult Male https://purl.org/pe-repo/ocde/ford#3.01.08 Sleep Apnea Physiology https://purl.org/pe-repo/ocde/ford#3.03.05 Acclimatization Polysomnography Clinical Sciences Medical Physiology 610 central sleep apnea lung 03 medical and health sciences 0302 clinical medicine Medical physiology Cardiovascular Medicine and Haematology 616 Humans Oximetry Interactive Ventilatory Support Lung Central https://purl.org/pe-repo/ocde/ford#3.03.11 Biomedical and Clinical Sciences Altitude Respiration noninvasive ventilation Middle Aged Respiration, Artificial Sleep Apnea, Central Healthy Volunteers Oxygen Treatment Outcome Artificial Female Sleep Research altitude
DOI: 10.1089/ham.2017.0147 Publication Date: 2018-03-29T17:06:51Z
ABSTRACT
Orr, Jeremy E., Erica C. Heinrich, Matea Djokic, Dillon Gilbertson, Pamela N. Deyoung, Cecilia Anza-Ramirez, Francisco C. Villafuerte, Frank L. Powell, Atul Malhotra, and Tatum Simonson. Adaptive servoventilation as treatment for central sleep apnea due to high-altitude periodic breathing in nonacclimatized healthy individuals. High Alt Med Biol. 19:178-184, 2018.Central sleep apnea (CSA) is common at high altitude, leading to desaturation and sleep disruption. We hypothesized that noninvasive ventilation using adaptive servoventilation (ASV) would be effective at stabilizing CSA at altitude. Supplemental oxygen was evaluated for comparison.Healthy subjects were brought from sea level to 3800 m and underwent polysomnography on three consecutive nights. Subjects underwent each condition-No treatment, ASV, and supplemental oxygen-in random order. The primary outcome was the effect of ASV on oxygen desaturation index (ODI). Secondary outcomes included oxygen saturation, arousals, symptoms, and comparison to supplemental oxygen.Eighteen subjects underwent at least two treatment conditions. There was a significant difference in ODI across the three treatments. There was no statistical difference in ODI between no treatment and ASV (17.1 ± 4.2 vs. 10.7 ± 2.9 events/hour; p > 0.17) and no difference in saturation or arousal index. Compared with no treatment, oxygen improved the ODI (16.5 ± 4.5 events/hour vs. 0.5 ± 0.2 events/hour; p < 0.003), in addition to saturation and arousal index.We found that ASV was not clearly efficacious at controlling CSA in persons traveling to 3800 m, whereas supplemental oxygen resolved CSA. Adjustment in the ASV algorithm may improve efficacy. ASV may have utility in acclimatized persons or at more modest altitudes.
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