ASV Algorithms & Central Sleep Apnea Management

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Imran Iftikhar and Dr. Rami Khayat to discuss groundbreaking research on adaptive servo-ventilation (ASV) and the newly released AASM clinical practice guidelines for central sleep apnea treatment. Dr. Iftikhar presents his innovative approach to analyzing ASV data through meta-analysis combined with trial sequential analysis, offering fresh insights into the statistical reliability of existing research beyond traditional systematic reviews. His work addresses lingering questions about ASV efficacy and safety that have persisted since the controversial SERVE-HF trial results challenged previous assumptions about this therapy. Meanwhile, Dr. Khayat, who served as vice-chair of the AASM task force, walks through the comprehensive evidence-based recommendations covering the full spectrum of central sleep apnea treatments. The guidelines address critical clinical decisions: When should CPAP be used over no treatment? Who requires BPAP with backup rates? Why does the task force recommend against BPAP without backup rates for central sleep apnea? What role do oxygen, acetazolamide, and transphrenic nerve stimulation play in treatment algorithms? The conversation delves into practical considerations including differences between ASV device algorithms from various manufacturers, the clinical impact of current device availability issues, and findings from Dr. Parthasarathy's bench study. The experts tackle the complex question of ASV use in patients with reduced ejection fraction and clarify important distinctions between primary central sleep apnea and treatment-emergent central sleep apnea (TECSA). This episode addresses the evolving landscape of central sleep apnea management, helping clinicians navigate evidence-based treatment decisions in an era of changing technology and updated safety considerations. Whether you're treating patients with heart failure, complex sleep-disordered breathing, or emerging central events during PAP therapy, this episode provides essential guidance for optimizing care. Join us for this comprehensive update that translates complex research findings into practical clinical applications.