Frequency and outcomes of primary central sleep apnea in a population-based study

Is idiopathic central sleep apnea a separate entity?

“…The high mortality rate (25%) was seemingly unrelated to cardiovascular causes but included 3 patients who had dementia with Lewy Bodies, raising the question whether autonomic dysregulation associated with this condition may contribute to the mortality associated with ICSA. 7 Taken in this context, the significant reductions in the arousal index seen at 6,12, and 18 months reported by Javaheri et al 1 are notable in the setting of associations between arousals from sleep and increased sympathetic tone. 10 Heretofore, adaptive servo-ventilation, has proven to be the methodology that most reliably suppresses CSA regardless of causation, 11 although application of adaptive servo-ventilation in heart failure with reduced ejection fraction remains controversial.…”

“…6 In other cases, a causative factor emerges that might have been present when the diagnosis of ICSA was made but was not detected at the time. A recent paper by Kouri et al 7 raises this possibility in a retrospective review of 25 patients with ICSA; after a median of 4.4 years, a significant number of patients with ICSA were diagnosed with cardiac arrhythmias, unstable angina, or heart failure. Notably, 5 of 25 patients had incident cognitive impairment/dementia with Lewy Bodies, an intriguing hint that CSA may be a harbinger of rapid eye movement sleep behavior disorder, although the direction of causality cannot be determined.…”

“…15,16 Furthermore, multiple studies validate that intermittent hypoxia perpetuates breathing instability 17,18 and persistent sympathetic excitation. 19,20 In the retrospective review by Kouri et al, 7 23 of the 25 patients with ICSA received treatment with PAP therapy; 17 were prescribed adaptive servo-ventilation and 6 were prescribed continuous PAP. Overall, PAP treatment was effective in substantially improving the degree of sleep-disordered breathing.…”

“…In 14 of 21 (67%) patients using their PAP device at the prescribed settings, the residual respiratory event index (REI) as estimated by the flow generator at the first follow-up visit was less than 15 events/hr; in 2 patients, the REI was >15 events/hr on adaptive servo-ventilation, and no download REI was available in 5 patients. 7 In contrast, the data from Javaheri et al 1 demonstrate essentially perfect adherence in the longest prospective study of patients with ICSA treated with TPNS to date, with slightly less improvement in the REI compared with PAP therapy reported by Kouri et al 7 It is also worth considering the contribution of obstructive airflow limitation to the residual REI in patients with ICSA treated by TPNS, given the high prevalence of an elevated body mass index in the studied individuals and the fact that hypopneas could not be identified as central or obstructive in mechanism; this is especially crucial in the context of other literature showing an increased propensity for CSA in patients with obstructive sleep apnea. 18 Indeed, treatment of residual obstructive airflow limitation with PAP could be considered concomitantly with TPNS in patients with a treated REI of >15 events/hr, especially when accompanied by residual symptoms as shown by quality-of-life measures.…”

Optimal NIV Medicare Access Promotion: Patients With Central Sleep Apnea

“…In a population-based study of primary CSA, 24% of the patients died during a median population follow-up duration of 4.4 years. 10 This high mortality rate may reflect unrecognized cardiac or neurologic comorbidities not known at the time of diagnosis. The prognostic implications of CSA on patients chronically using opioids are not known.…”