Adaptive Servo Ventilation: Treatment for Central Sleep Apnea

Adaptive Servo Ventilation (ASV) – is a medical technology that utilizes positive airway pressure ventilatory support that is adjusted based on the detection of apneas, or pauses in breathing, during sleep. It is primarily used in the treatment of Central Sleep Apnea. It is also used for complex sleep apnea, mixed sleep apnea, periodic breathing – Cheyne – Stokes respirations. The device resembles CPAP machines (Continuous Positive Airway Pressure) and uses the same masks, hoses, and attachments.

How is Adaptive Servo Ventilation (ASV) different from CPAP and BiPAP?

While CPAP provides one continuous pressure, and BiPAP provides two pressures (on inhale and exhale), ASV adjusts the pressure based on an algorithm.

ResMed’s devices is called Adapt SV.

How Adaptive Servo Ventilation (ASV) Works

Per ResMed’s website, the algorithm is programmed as follows:

“The patient’s own recent average respiratory rate—including the ratio of inspiration to expiration and the length of any expiratory pause.The instantaneous direction, magnitude, and rate of change of the patient’s airflow, which are measured at a series of set points during each breath. A backup respiratory rate of 15 breaths per minute.”

 “By ventilating the patient appropriately during periods of hypopnea and apnea and reducing support during periods of hyperventilation and normal breathing,the ASV algorithm rapidly stabilizes breathing patterns and arterial blood gases and minimizes discomfort and arousals often associated with bilevel treatment.”

 

Adaptive Servo Ventilation
Similar design of Adaptive Servo Ventilation Unit

Comparison of CPAP, BiPAP, APAP (auto-PAP) and Adaptive Servo Ventilation (ASV) are described in the above sections.

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3 Replies to “Adaptive Servo Ventilation: Treatment for Central Sleep Apnea”

  1. Dawn Capewell

    My friend has been diagnosed with severe sleep apnea. She was not able to use the CPAP until she had developed a buildup of CO2, and was rushed to the hospital. They wanted to put her on BiPap, but the machine was so big and invasive that she would not tolerate it. Now I read that the BiPap uses the same masks and supplies as CPAP. Can you tell me why the hospital BiPap was so much different than the CPAP? Does ASV use the same masks and supplies as CPAP? How does she know if she needs ASV?

    • rick gerken

      Don’t know if anyone answered you yet but I can tell you the hospital BIPAP (at last the model that would be used in a “critical” situation) is usually the “Cadillac” of BIPAPS. Home PAP units only need to be set and then forgot, with a re-evaluation every couple of years, the hospital units need to be able to cover a wide variety of modes (CPAP, BIPAP, AVS, AVAPS, etc.) and accommodate a variety of masks and tubings. The feel of the therapy should be the same, 10 cm/h20 is 10 cm/h20 whether it is being delivered by a large machine or small. I would guess that when your friend was brought in, the ER staff probably set the machine up higher settings because she was in an acute attack, and that probably made it hard to tolerate, also they probably didn’t use a mask that she was familiar with, and lastly your friend was probably quite anxious to start with and the emergent setting would have made her more anxious (like a viscous circle). As for your friend’s need of ASV, they would be able to ascertain her need from a formal, in house sleep study. ASV seems to be geared towards the sleep apnea patient with a “central” apnea, which is more rare than the more common obstructive apnea. I hope this helped.

      Rick, therapist x 30 years at a mid-sized, regional hospital.

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