Cautions and strategy for treating chronic heart failure by using adaptive servo-ventilation.

n 1998, Japanese universal public health insurance approved cover for the home care use of continuous positive airway pressure (CPAP) for sleep apnea syndrome (SAS). The Japanese Ministry of Health, Labor and Welfare criteria for health insurance coverage for CPAP are as follows: “anyone who as the result of polysomnography (PSG) has an apnea hypopnea index (AHI) ≥20 with subjective symptoms such as sleepiness”, and “people whose result of the portable monitor test is AHI ≥40, and who have subjective symptoms”. Currently, many patients with SAS in Japan receive in-home treatment with CPAP covered by public health insurance. Meanwhile, in 2004, home oxygen therapy (HOT) for patients with chronic heart failure (CHF) and Cheyne-Strokes respiration (CSR) was approved for health insurance coverage with different criteria from CPAP. In 2007, adaptive servoventilation (ASV) was approved as one of home mechanical ventilation by the health insurance, and then ASV has been applied to the treatment of CHF patients whose condition was stable. In order to prescribe ASV, the physician has to have evidence that the patient requires long-term continuous pressure support ventilation that is able to change the tidal volume and respiratory rate. At last, in 2010, the Japanese Circulation Society published “Guidelines for Diagnosis and Treatment of Sleep Disordered Breathing in Cardiovascular Disease; JCS2010 (Chief, Dr Momomura)”, and it heated up the discussion about which and how of CPAP, HOT and ASV should be properly prescribed for cardiovascular patients. Accordingly, considering the present status of medical affairs in Japan, we describe cautions and strategy for treating CHF by using ASV.