In which patient population should ASV be avoided according to recent information?

Adaptive servo-ventilation (ASV) is a specialized form of positive airway pressure therapy primarily used for patients with central sleep apnea, particularly those who also have heart failure. The recommendation to avoid ASV in patients with heart failure with reduced ejection fraction (HFrEF) and central sleep apnea is based on recent studies indicating that this combination can be associated with worse outcomes.

Research has shown that the use of ASV in patients with HFrEF can potentially lead to adverse cardiovascular effects. Specific concerns arise because ASV can lead to increased mortality in this population, possibly due to the complex interactions of respiratory support, hemodynamic effects, and the underlying pathophysiology of heart failure. As a result, clinical guidelines recommend against its use in these patients.

In contrast, other patient groups such as those with hypertension, CPAP responders, or those undergoing surgery are typically not advised against ASV therapy. For example, patients with hypertension do not have a direct contraindication to ASV, and those who respond positively to continuous positive airway pressure (CPAP) therapy may have suitable alternatives. Likewise, patients undergoing surgery would be assessed on a case-by-case basis rather than universally avoided for ASV therapy.