Introduction Adaptive Servo-Ventilation (ASV) is used to treat central sleep apnoea (CSA), but evidence for its use is limited. A large trial, SERVE-HF, randomised patients with CSA and left ventricular heart failure to ASV or control. Their results led to a field safety notice in May 2015, advising ASV is contraindicated in patients with symptomatic chronic heart failure and reduced ejection fraction. Sleep Centres therefore reviewed ASV in clinical practice; we sought information about ASV use in the UK.
Methods A survey was sent to 187 UK sleep centres, asking about the use of ASV.
Results Seventy-five surveys were returned (40% response rate). ASV was not used in 53% of centres.
Of the 47% (n = 35) of sleep centres using ASV, the average number of patients on ASV per centre was 13 (range 1–69). For comparison, the average number on CPAP was 3368 (range 100–12000).
Of the 454 patients using ASV, the reasons are shown in Table 1.
Following the field safety notice, 66% of centres reviewed patients in clinic. Others contacted patients by phone (45%) or in writing (31%), or used a combination of these. Five centres did not contact their patients and five centres had to run between one and two additional clinics to review their ASV patients. Some repeated echocardiography.
Seventy-two (48%) CSA-CSR patients were advised to stop using ASV. Fifteen chose to continue, 32 changed to CPAP/NIV, 14 stopped ASV, 11 were not specified.
Clinicians rated ASV as very useful (26%), quite useful (23%) and occasionally useful (49%).
Conclusions There is a wide range of clinical ASV use in sleep centres across the UK; many do not use it. Apart from SERVE-HF, there are few randomised clinical trials to inform who would benefit from ASV. Use may be determined by case series, expert opinion and individual response. This highlights the need for further research in this area.
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