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ASV clinical benefits

The treatment of central SDB with ASV therapy offers significant benefits, including improvements in AHI, a reduction in respiratory events and alleviation of daytime sleepiness.

Treat your patients with CSA

What does real-world data tell us about ASV?​

ASV showed better control of respiratory events than CPAP in patients with CompSA

In an intention-to-treat analysis, success (apnea hypopnea 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.1

[N = 66, prospective randomised trial]

ASV-CompSA

ASV reduces residual sleepiness after APAP therapy in patients with mixed sleep apnea

After 30 days of APAP treatment, ASV provided a further reduction (compared to baseline) of 12.9% in AHI, 48.5% in central sleep apnea index (CSAI), 26.1% in micro-arousal index (MAI), and 37.9% in Epworth Sleepiness Scale (ESS) score at similar mean pressure.2

[N = 42, sequential study]

ASV-APAP

In a small retrospective analysis, ASV improved AHI and ESS in patients following acute ischaemic stroke

In opioid-induced CSA, ASV therapy reduced AHI by 84.7%, central apnea index (CAI) by 95.7%, apnea 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 ASV Auto, but only 33.3% of patients on bi-level ST.3

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

ASV-CSA

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%.4

[N = 15, single centre retrospective analysis]

ASV-AHI

A decade of evidence brings clarity to ASV

Since 2015 and the results of SERVE-HF,5 the indications for use of ASV therapy have been revised. According to ERS consensus statement from 2017,6 ASV should be prescribed in cases of persistent CSA with AHI ≥ 15 per hour despite CPAP treatment, except in patients with symptomatic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%), and moderate to severe CSA.

The 2025 ERS/ESRS7 statement supports ASV is safe and effective for selected CSA patients with heart failure, except those with chronic, symptomatic heart failure (NYHA II–IV) and LVEF ≤ 45%, or moderate to severe central sleep apnea. ASV may be considered for other CSA types, including treatment-emergent, drug-induced, neurological, or idiopathic CSA. For symptomatic patients with LVEF 30–45% unresponsive to CPAP, ASV should only begin in expert centres with close specialist monitoring.

ASV graph

Adapted from the ERS and AASM statements about CSA.

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.

READ-ASV registry: indications and benefits of ASV in real life

READ-ASV8, launched in 2017, looked at the clinical benefits of ASV therapy in 801 patients in real-life settings.

The findings from the READ-ASV study8 reveal that ASV therapy is primarily used in clinical practice for patients with treatment-emergent central sleep apnea (TE-CSA) and CSA with cardiovascular disease.

These patients experienced symptoms such as impaired quality of life, sleepiness, and low sleep quality, which were improved with ASV treatment, especially in individuals with pre-existing sleep disordered breathing (SDB).

READ-ASV registry

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.
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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.

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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.

FACE registry: adopting a phenotyping approach with ASV

The FACE registry9,10 enrolled 503 heart failure patients from 2009 to 2018, with reduced ejection fraction before 2015, and then with preserved ejection fraction only after 2015. Among the 324 patients who underwent the two years follow-up, the analysis distinguished six phenogroups of patients and highlighted the existence of various phenotypes in chronic heart failure patients eligible for ASV therapy.

Results have shown that, compared to ASV non-users, three phenotypes had a better prognosis on morbi-mortality with ASV treatment: namely patients with HFmrEF/HFpEF (heart failure with mid-range ejection fraction/heart failure with preserved ejection fraction); patients with obstructive sleep apnea (OSA) or CSA-OSA; and patients who are older, male and obese. The phenotype that benefited the most included older, obese, hypoxic and hypertensive patients.

  FACE registry

 

ASV: the big picture arrow-wht

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.
Read More
Treatment options for OSA
Resmed offers a range of effective treatment options for OSA, including CPAP, APAP, bilevel therapy and oral appliance therapy.
Read More
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ASV videos: watch experts talking about ASV therapy

asv-video1

Professor Michael Arzt, Professor of Internal Medicine, Regensburg, Germany speaks on what evidence-based medicine says about ASV therapy.

Watch now
asv-video-2
Prof. Jean-Louis Pépin, PU-PH in Clinical Physiology, head of the HP2 research laboratory, Grenoble, France speaks on the practicalities of ASV therapy.
Watch now

How to treat your patients with central sleep apnea

Discover how Resmed adaptive servo-ventilation (ASV)* solution promotes harmony, safety and comfort.

Learn more
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More about treatment options

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Treatment options for CSA
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Explore AirCurve 11 ASV
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References
1

Morgenthaler TI, et al. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. Sleep. 2014 May 1;37(5):927-34. doi: 10.5665/sleep.3662.

2

Su M, et al. Adaptive pressure support servoventilation: a novel treatment for residual sleepiness associated with central sleep apnea events. Sleep Breath. 2011 Dec;15(4):695-9. doi: 10.1007/s11325-010-0424-6.

3

Cao M, et al. A novel adaptive servoventilation (ASVAuto) for the treatment of central sleep apnea associated with chronic use of opioids. J Clin Sleep Med. 2014 Aug 15;10(8):855-61. doi: 10.5664/jcsm.3954.

4

Brill AK, et al. Adaptive servo-ventilation as treatment of persistent central sleep apnea in post-acute ischemic stroke patients. Sleep Med. 2014 Nov;15(11):1309-13. doi: 10.1016/j.sleep.2014.06.013.

5

Cowie MR & al. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. New England Journal of Medicine, 2015 Sep 17;373(12):1095-105. doi: 10.1056/NEJMoa1506459

6

Randerath et al. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep ERJ 2017 49: 1600959 https://erj.ersjournals.com/content/49/1/1600959 

7

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

8

Arzt M et al. Effects of Adaptive Servo-Ventilation on Quality of Life: The READ-ASV Registry. Ann Am Thorac Soc. 2024 doi:10.1513/AnnalsATS.202310-908OC

9

Tamisier R et al. FACE study: 2-year follow-up of adaptive servo-ventilation for sleep-disordered breathing in a chronic heart failure cohort. Sleep Med. 2024 doi:10.1016/j.sleep.2023.07.014

10

Tamisier R et al. Adaptive servo ventilation for sleep apnoea in heart failure: the FACE study 3-month data. Thorax. 2022 doi:10.1136/thoraxjnl-2021-217205

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