Best Treatment For Complex Sleep Apnea/Central Sleep Apnea Is ASV Or CPAP:a Meta Analysis

OBJECTIVE:This study was performed to investigate the best treatment choice for the treatment of complex sleep apnea syndrome (CompSAS)/Central sleep apnea syndrome (CSAS) and to see which therapy is superior among adaptive servo ventilation (ASV) and continuous positive airway pressure (CPAP).DATA SOURCES:Data was retrived using English language search of PubMed, The Cochrane Database of Systemic Reviews, Conference abstracts and original articles. Reference sections of the identified studies were also examined for additional search of studies. Data on sample size, participant’s characteristics, study design, intervention type, follow up duration and treatment results were assessed by independent reviewers using standard protocol.REVIEW METHODS:ASV is the promising technique in the treatment of complex sleep apnea syndrome (CompSAS)/central apnea syndrome (CSAS). When the use of other devices failed to show improvement in PSG, we conducted Meta analysis to compare the effect of CPAP and ASV. We took3variables AHI, CAI, RAI to see the effect of CPAP and ASV on these variables. We also did second Meta analysis as well, to see the effect on left ventricular ejection fraction (LVEF) after treatment with ASV as compared to other devices. In first Meta analysis, data from3trials with99participants were examined by random effects model. In second part of Meta analysis, data from4trails with97participants were taken and analysied by random effects model.RESULTS:Randomized controlled trial, Prospective randomized crossover clinical trial, retrospective study, all three studies in ASV showed greater reduction of PSG levels than CPAP. For ASV AHI, CAI, RAI reduction percentages were72.23%,84.56%,80.36%respectively and for CPAP reduction percentages were52.12%,-1.82(increased PSG levels),33.52%.. The pooled net change in AHI, CAI, RAI for those treated with ASV and CPAP0.9621(95%CI:0.59-1.32);0.95(95%CI:0.58-1.32);0.7(95%CI:0.33-1.07) respectively. Net reductions in PSG levels were significant with treatment by ASV. The net change in LVEF level after treatment with ASV as compared to other therapy, like continuous positive airway pressure, sub-therapeutic ASV, oxygen were0.71(95%CI:0.29-1.12). These results indicate ASV is better treatment so far for the treatment of complex sleep apnea syndrome and central sleep apnea syndrome. To determine the impact of study design sensitivity analysis was done. Publication bias analysis revealed a likelihood of few missing studies.CONCLUSION:This analysis suggest that treatment with ASV leads to statistically significant reduction in AHI,CAI,RAI level and LVEF as compared to CPAP treatment.