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Respiratory center function in patients under adaptive servoventilation: etiology and outcome
Isabel Martinez-Gonzalez Posada1, Ramón Fernández Álvarez2, Andres Ortiz Reyes1
1Respiratory Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
Study Objectives:
Central sleep apnea (CSA) is a sleep disorder characterized by instability in the respiratory center's function, leading to an excessive ventilatory response. The most effective treatment for these patients is adaptive servoventilation (ASV). We hypothesize that individuals with CSA may exhibit hyperresponsiveness of the respiratory center, and ASV treatment could normalize its function. We aimed to measure the ventilatory response to hypercapnia and its relationship with the outcomes following ASV treatment.
Methods:
A prospective study with repeated measurements was conducted on patients with CSA treated with ASV. A ventilatory response to a hypercapnia test was performed using p0.1/pEtCO2 determinations: a first determination at the time of inclusion and a second one after at least 6 months of ASV treatment. We used the Pearson correlation test and the comparison of means (t test) for independent and paired variables for statistical analysis. A p0.1/pEtCO2 value of 0.43 cmH2O/mmHg was considered the reference value.
Results:
We analyzed 46 participants, 82% male. The apnea-hypopnea index was 47 events/h (23), and the central apnea-hypopnea index was 27 events/h (12). The initial p0.1/pEtCO2 was 0.48 (standard deviation: 0.24) cmH2O/mmHg, significantly higher than the reference value (P = .02). After ASV treatment, 63% of participants had a normalized p0.1/pEtCO2, which decreased to 0.37 (standard deviation: 0.23) cmH2O/mmHg and was significantly lower than the initial value (P = .015) and comparable to the reference value (P = .26). CSA secondary to opioid use had a substantially lower p0.1/pEtCO2: 0.27 cmH2O/mmHg (standard deviation: 0.11; P = .021).
Conclusions:
Ventilatory response to hypercapnia in patients with CSA and ASV treatment could differentiate phenotypes and impact therapeutic decisions.
Citation:
Posada IM-G, Álvarez RF, Ortiz Reyes A, et al. Respiratory center function in patients under adaptive servoventilation: etiology and outcome. J Clin Sleep Med. 2025;21(9):1539-1545.
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