Current and Future Use of Adaptive Servo-Ventilation

Adaptive servo-ventilation (ASV) is a form of non-invasive positive airway pressure (PAP) therapy that differs from other PAP devices. It includes features to overcome both obstructive and central sleep-disordered breathing (SDB) events. In the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo-Ventilation in Patients with Heart Failure (SERVE-HF) study, ASV significantly reduced SDB events in patients with systolic heart failure (HF) and predominant central sleep apnoea (CSA), but did not improve outcomes, and there was increased mortality risk in the ASV group. Although the SERVE-HF results represent a paradigm shift for ASV, they are only applicable to a small subset of ASV-treated patients, and there is no evidence suggesting that ASV use should stop altogether. There are a number of other indications and patient groups for whom ASV may be useful, effective and safe, including patients with treatment-emergent CSA, central apnoeas associated with long-term opioid therapy without alveolar hypoventilation, idiopathic Cheyne-Stokes respiration, after ischaemic stroke and those with HF with preserved ejection fraction. Additional research is required to better define the mechanism of increased risk associated with ASV identified in SERVE-HF and to more clearly characterise the specific patient phenotypes who benefit from ASV therapy.