How to treat your patients with CSA

Who is ASV* therapy suitable for?

ASV may be considered for patients with left ventricular ejection fraction (LVEF) >45%, where there is a clinical rationale for its use..^1,2,3,4

Reduced LVEF should be excluded before starting ASV.¹ Before using ASV, it is important to ensure that LVEF is >45%. Echocardiography¹³ is recommended for this purpose.

Experts’ statements^1,2,3,4 and healthcare authorities agree that patients with LVEF>45% remain eligible for ASV when there is a clinical rationale for using it. ASV is eligible in these different situations.^1,2,3,4

The 2025 AASM guidelines and the latest ERS statement on ASV⁵ recommend considering ASV therapy for patients with:

Idiopathic central sleep apnea (CSA)
Drug‑induced CSA
Treatment‑emergent CSA (TECSA)
CSA associated with medical or neurological disorders
CSA in heart failure*
Predominant obstructive sleep apnea (OSA) when CPAP is insufficient

Find out more about the Resmed device that uses ASV therapy: AirCurve 11 ASV

Understand how our ASV algorithm works

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Central sleep apnea

Periodic breathing

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ASV better than CPAP at controlling respiratory events in patients with CompSA

In an intention-to-treat analysis, success (apnoea hypopnoea index [AHI] < 10) at 90 days of therapy was achieved in 89.7% of patients treated with ASV versus 64.5% of participants treated with CPAP.⁶

[N = 66, prospective randomised trial]

ASV decreases residual sleepiness after APAP therapy in patients with mixed sleep apnoea

After 30 days of APAP treatment, ASV provided a further reduction (compared to baseline) of 12.9% in AHI, 48.5% in central sleep apnoea index (CSAI), 26.1% in micro-arousal index (MAI), and 37.9% in Epworth Sleepiness Scale (ESS) score at similar mean pressure.⁷

[N = 42, sequential study]

ASV better than bi-level ST at reducing respiratory events in opioid-induced CSA

In opioid-induced CSA, ASV therapy reduced AHI by 84.7%, central apnoea index (CAI) by 95.7%, Apnoea Index (AI) by 96.4%, and respiratory arousal index (RAI) by 77.1% when compared to bi-level ST. Respiratory parameters were normalised in 83.3% of patients on ASVAuto but only 33.3% of patients on bi-level ST.⁸

[N = 18, prospective, randomised crossover polysomnography study]

ASV improves AHI and ESS in post-acute ischemic stroke patients

ASV therapy improved outcomes for post-acute ischemic stroke patients with CSA, reducing AHI by 81.8% and ESS by 35.6%.⁹

[N = 15, single centre retrospective analysis]

AirCurve 11 ASV for your CSA patients

Designed to stabilise breathing and personalise therapy for patients with CSA, OSA, mixed apneas or periodic breathing. This is achieved through:

Variable inspiratory pressure support

Constant and adjustable expiratory positive airway pressure (EPAP)

Respiratory support synchronised with the patient's breathing

Explore AirCurve 11 ASV

Central sleep apnoea treatment options

Continuous positive airway pressure or automatic positive airway pressure (CPAP/APAP) therapy is often used as the treatment of first intention, but experience shows that CPAP/APAP does not consistently control apnoeas or improve symptoms. As a result, some patients treated with CPAP/APAP remain symptomatic. This increases the risk of non-compliance and the likelihood that they will require multiple, resource-intensive interventions.

Adaptive servo-ventilation* is often an appropriate choice for treating these more complex patients, either as a first intention therapy or after an unsuccessful trial with other positive airway pressure (PAP) therapies.

Adaptive-servo ventilation: a proven solution for CSA

Adaptive servo-ventilation (ASV) is an evidence-based therapy designed to stabilise breathing patterns in appropriately selected patients with CSA. ASV dynamically adjusts pressure support in response to the patient’s ventilatory needs throughout the night.

Current clinical guidance supports consideration of ASV in adults with several forms of CSA, including:

Primary CSA
Treatment-emergent CSA
CSA associated with medical conditions
CSA related to medication or substance use

Treatment decisions should remain individualised and based on:

Clinical evaluation
Underlying aetiology
Symptom profile
Cardiac status
Contraindications
Shared decision-making between clinician and patient

Compared to other forms of PAP therapy, ASV offers significant benefits for the treatment of central sleep-disordered breathing.* This has been demonstrated in multiple clinical trials across various patient types.

ASV clinical benefits

LVEF and patient selection

Assessment of left ventricular ejection fraction (LVEF) forms part of the broader clinical evaluation when considering ASV therapy.

Patients with LVEF >45% may be considered for ASV therapy when clinically appropriate and in the absence of contraindications.

In patients with heart failure and reduced ejection fraction, treatment decisions should follow current guideline recommendations and specialist clinical judgement, with careful monitoring and follow-up.

CPAP, APAP and bilevel therapy

Positive airway pressure therapy can be delivered in a number of modes:

Continuous positive airway pressure (CPAP), which delivers air at a fixed pressure.
Automatic positive airway pressure (APAP), which automatically adjusts pressure levels based on a patient's breathing. APAP may be suitable for patients with REM-related sleep apnea, positional apnea or who experience non-compliance with standard CPAP therapy.
Bilevel therapy, which provides higher inspiratory pressure (IPAP) and lower expiratory pressure (EPAP) - can also be effective for certain OSA patients who are non-compliant, and used to treat a wide-range of sleep and respiratory disordered breathing other than OSA such as include CSA, overlap syndrome, COPD, and more.

Patient outcomes and comorbidities

Helping your patients start and continue with the most effective sleep apnea treatment can help them regain control of their lives. Effective treatment has been shown to reverse the effects of daytime sleepiness, fatigue, moodiness and depression. And studies have shown that when patients are successful with their therapy, their long-term health care costs are at least 50% lower overall.¹

There are also a variety of serious comorbidities such as cardiovascular disease, diabetes and stroke that have a strong connection to sleep apnea.

Positive airway pressure (PAP) therapy

Positive airway pressure therapy is widely regarded as the most effective way to treat OSA.¹ It works by creating a "pneumatic splint" for the upper airway, preventing the soft tissues of the upper airway from narrowing and collapsing. Pressurised air is sent from a therapy device through air tubing and a mask that patients wear over their nose or mouth, through to the upper airway.

As a result of positive airway pressure therapy, a patient with severe sleep apnea may experience a return to a normal sleep pattern once his or her sleep debt resolves.

Resmed's AirSense and AirCurve series of devices have helped patients sleep through the four hour compliance threshold. AirSense and AirCurve devices are stylish and quiet, and provide a variety of unique features that are designed to deliver a more comfortable sleeping experience for your patients.

CPAP, APAP and bilevel therapy

Positive airway pressure therapy can be delivered in a number of modes:

Continuous positive airway pressure (CPAP) - which delivers pressurised air at one fixed pressure.
Automatic positive airway pressure (APAP) therapy - which automatically adjusts pressure levels based on a patient's breathing patterns. This may be particularly suited to patients with REM-related sleep apnea, positional apnea or those who are non-compliant with standard CPAP therapy.
Bilevel therapy - which provides higher inspiratory pressure (IPAP) and lower expiratory pressure (EPAP) - can also be effective for certain patients who are non-compliant, and used to treat a wide-range of respiratory disorders.

Oral appliance therapy

An oral appliance, often called a mandibular repositioning device (MRD), can be a second line therapy option and can be considered for patients with mild to moderate sleep apnea. It is a custom-made, adjustable oral appliance available from a dentist that holds the lower jaw in a forward position during sleep. This mechanical protrusion expands the space behind the tongue, puts tension on the pharyngeal walls to reduce collapse of the airway and diminishes palate vibration.

Alternative treatment options

Surgery is also an option for treating sleep apnea, but as with all surgeries there are associated risks.

Uvulopalatopharyngoplastry (UPPP) has been widely used to treat snoring or OSA, but is not recommended as the first choice treatment option². This surgical procedure involves the removal of the tonsils, soft palate/uvula and closure of the tonsillar pillars and certain risks are involved³.

More about treatment options for sleep-disordered breathing

ASV clinical benefits

Compared to other forms of PAP therapy, ASV can offer significant benefits for the treatment of central SDB.* This has been demonstrated in multiple clinical trials across various patient types.

Treatment options for OSA

Resmed offers a range of effective treatment options for OSA, including CPAP, APAP, bilevel therapy and oral appliance therapy.

myAir

Resmed ASV patient Fred Schouwenaars

Discover Fred Schouwenaars’s story, a patient with central sleep apnoea. He’s joined by his Sleep Physician, Prof. Venekamp, Pulmonologist and Sleep Physician at the Institute Kempenhaeghe in the Netherlands.

Resmed ASV physician

Watch Professor Venekamp, Pulmonologist and Sleep Physician at the Institute Kempenhaeghe in the Netherlands, talk about her experience with adaptive-servo ventilation therapy and her patient Fred Schouwenaars.

Resmed ASV Professor Pépin

Watch Professor Pépin, Head of Sleep Laboratory in Grenoble, France, share clinical updates about adaptive-servo ventilation therapy.

Looking for more information about CSA and ASV?

AirCurve 11 ASV

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Learn more about central sleep apnea

Treatment options for CSA

References

d’Ortho et al. European Respiratory & Pulmonary Diseases, 2016;2(1):Epub ahead of print. http://doi.org/10.17925/ERPD.2016.02.01.1.

Priou P & al. Adaptive servo-ventilation: How does it fit into the treatment of central sleep apnoea syndrome? Expert opinions. Revue des Maladies Respiratoires, 2015 Dec, 32(10):1072-81.

Aurora RN & al. Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: “The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses”. Journal of Clinical Sleep Medicine, 2016 May 15, 12(5):757-61.

Randerath W et al. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep ERJ Express. Published on December 5, 2016 as doi: 10.1183/13993003.00959-2016

Badr, M., Khayat, R., Allam, J. et al. Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 21, 2181–2191 (2025). https://doi.org/10.5664/jcsm.11858

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Who is ASV* therapy suitable for?