A 48-year-old man, with a history of systemic light-chain amyloidosis and heart failure, presented with snoring during sleep. He underwent sleep examination by portable monitor, which revealed sleep apnea syndrome (SAS) with an apnea-hypopnea index (AHI) 45.4/h. He started auto-adjusting continuous positive airway pressure (auto-CPAP) treatment. The memory stick of the CPAP machine showed that he used auto-CPAP for an average 5.5 h/night, and that the AHI was 48.3/h. The 4% oxygen desaturation index determined from pulse oximetry was 6.05/h during auto-CPAP treatment. We considered that auto-CPAP treatment was inadequate as a treatment for SAS in this patient and therefore decided to change the ventilator to adaptive servo-ventilation (ASV). The memory stick of the ASV machine showed that he used ASV for an average 5.5 h/night, and the AHI was 4.8/h. Although auto-CPAP treatment did not improve the left ventricular ejection fraction (LVEF) on echocardiography form 47% to 47%, ASV treatment improved LVEF from 47% to 58%.
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