Institute for Continuing Education

Adaptive Servoventilation Versus Continuous Positive Airway Pressure

Course Objectives

Upon successful completion of this module, you will be able to:

• Differentiate obstructive sleep apnea (OSA), central sleep apnea (CSA), and complex sleep apnea (CompSA) based on pathophysiology, polysomnographic findings, and clinical presentation, understanding the role of respiratory control instability, loop gain, and cardiovascular comorbidities in central apnea genesis.
• Explain the technical principles of adaptive servo-ventilation (ASV) including automatic adjustment of inspiratory pressure support, backup respiratory rate, end-expiratory pressure, and algorithmic response to detected apneas and hypopneas, contrasting these mechanisms with continuous positive airway pressure (CPAP), bilevel positive airway pressure (BPAP), and other positive airway pressure modalities.
• Identify appropriate clinical indications for ASV therapy including central sleep apnea with Cheyne-Stokes respiration, treatment-emergent central sleep apnea (complex sleep apnea), and other central apnea patterns, while recognizing absolute and relative contraindications particularly in heart failure with reduced ejection fraction based on current clinical trial evidence.
• Apply evidence-based patient selection criteria for ASV versus CPAP or alternative therapies, synthesizing polysomnographic data, cardiovascular status including ejection fraction assessment, CSA/OSA pattern characterization, and individual patient factors to support appropriate treatment recommendations.
• Perform ASV titration during attended polysomnography using standardized protocols, adjusting end-expiratory pressure (EPAP), pressure support settings, and other parameters to eliminate respiratory events while optimizing patient comfort, tolerability, and treatment adherence.
• Interpret comparative effectiveness data from clinical trials and real-world studies evaluating ASV versus CPAP for central sleep apnea syndromes, integrating findings on apnea-hypopnea index reduction, sleep quality improvement, cardiovascular outcomes, and mortality data to inform evidence-based practice.
• Communicate effectively with patients, families, and healthcare teams about ASV therapy rationale, expected benefits and risks, differences from CPAP, adherence requirements, and the sleep technologist's role in titration, device setup, patient education, and ongoing support within appropriate scope of practice.

Course Information

With its advanced Adaptive-Servo Ventilation (ASV) algorithm, the ResMed VPAP Adapt SV provides ventilatory support to rapidly treat all forms of central sleep apnea (CSA), mixed apnea and periodic breathing, commonly known as Cheyne-Stokes respiration (CSR).

To determine the degree of pressure support needed, the ASV algorithm continuously calculates a target ventilation. Based on respiratory rate and tidal volume, the target is 90% of the patient’s recent average ventilation—that means that ventilation can vary gradually and naturally over the course of the night.