The Significance and Outcome of Continuous Positive Airway Pressure-Related Central Sleep Apnea During Split-Night Sleep Studies

Dernaika, Tarek A.; Tawk, Maroun M.; Nazir, Shoab A.; Younis, Walid G.; Kinasewitz, Gary T.

doi:10.1378/chest.06-2562

Cited by 123 publications

(83 citation statements)

References 25 publications

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“…Our goal was to perform a clinical study whereby patients were receiving usual care rather than being heavily instrumented, as normally is performed in our physiology laboratory. Some authors have suggested that treatment-emergent central apneas may be a function of poor sleep quality (i.e., state transition apneas), 13 and thus our goal was to give standard instrumentation for clinical polysomnography rather than for an invasive physiological study. Moreover, a tightly sealed nasal mask to assess airflow would have defeated the purpose of our study from the standpoint of leak assessment.…”

Section: Discussionmentioning

confidence: 99%

“…12 Prior observational studies have also supported that for the majority of patients, the central apneas resolve with time. 13 Patients who have a poor initial experience with CPAP may be reluctant to use CPAP in the long term; therefore, stabilization of breathing acutely may have benefi ts. On the other hand, expensive newer devices may be unnecessary if the breathing pattern is likely to stabilize spontaneously without any impact on clinical outcome.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

See 1 more Smart Citation

Air Leak during CPAP Titration as a Risk Factor for Central Apnea

Montesi

Bakker

Macdonald

et al. 2013

Journal of Clinical Sleep Medicine

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Section: Discussionmentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Air Leak during CPAP Titration as a Risk Factor for Central Apnea

Montesi

Bakker

Macdonald

et al. 2013

Journal of Clinical Sleep Medicine

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“…Some studies have shown that in the majority of patients with CompSAS, CAI lowers significantly during followup, with improvement in sleep efficiency, a decrease in wake after sleep onset, and a lower number of arousals in comparison with the baseline diagnostic night (16). However, CPAP seems to be effective in some patients, while ineffective in others; CompSAS may develop de novo in 4% of OSAS patients treated with CPAP during follow up (17).…”

Section: Editorialmentioning

confidence: 99%

“…Hence, this will result in an interruption of inspiration. This mechanism protects the lungs against overexpansion, and is called the HeringBreuer reflex (16). Moreover, in some patients (e.g., those more preload dependent or those with low ventricular filling pressures) CPAP over-titration may determine a drop of cardiac output, which may further promote ventilatory control instability due to circle time lengthening.…”

Section: Editorialmentioning

confidence: 99%

Central sleep apnea during continuous positive airway pressure therapy in obstructive sleep apnea patients: from the compliance to adaptation, maladaptation and reflexes

Lombardi¹,

Caravita²,

Parati³

2017

J. Thorac. Dis.

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“…24 Sleep fragmentation with frequent sleep-wake transitions occurring with initiation of CPAP can lead to central apneas. 25 Adaptive servoventilation (ASV) has been shown to be superior to CPAP in treating central sleep apnea, but there have been no long-term studies showing superior clinical outcomes. 26,27 There are currently two ongoing multicenter, randomized controlled trials, ADVENT-HF and SERVE-HF, 31 to evaluate the cost effectiveness and efficacy of ASV in treating patients with heart failure and central sleep apnea.…”

Section: Report Of Casementioning

confidence: 99%

Treatment of Cardiomyopathy with PAP Therapy in a Patient with Severe Obstructive Sleep Apnea

Grewal

2012

Journal of Clinical Sleep Medicine

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Obstructive sleep apnea is common in patients with heart failure. This case illustrates that treatment with PAP therapy can improve cardiac function in patients with both conditions. CPAP-emergent central apnea, as seen in this patient, has multiple etiologies. It is commonly seen in patients with severe sleep apnea, usually resolves over time, and does not need treatment with adaptive servoventilation. keywords: Heart failure, obstructive sleep apnea, PAP therapy, CPAP-emergent central sleep apnea Citation: Grewal RG. 2 Despite its association with cardiovascular diseases, sleep apnea remains underdiagnosed in patients with heart disease.3,4 Meanwhile, there has been increased development and promotion of new, advanced, and more expensive devices by industry to treat sleep apnea despite the lack of any evidence that these devices have superior clinical outcomes. 5 Following is a case which highlights both these issues. repOrt Of CaSeTC, a 44-year-old obese African American male with a BMI of 41, longstanding history of hypertension, non-smoker, with no history of alcohol use, and a 2-3 year history of progressively increasing shortness of breath and cough, was diagnosed with New York Heart Association (NYHA) class III heart failure (HF) in July 2008. Electrocardiogram (ECG) fi ndings were notable for biatrial abnormality and borderline left ventricular (LV) hypertrophy, with no evidence of heart block. Echocardiogram showed severe dilation and global hypokinesis of LV with a LV ejection fraction (LVEF) of 10% and moderately reduced right ventricular (RV) function. Left heart catheterization did not show any occlusive coronary artery disease. Right heart catheterization showed elevated right atrial (RA) pressure at 17 mm Hg, pulmonary capillary wedge pressure (PCWP) of 30 mm Hg, pulmonary artery (PA) pressure of 74/30 mm Hg, and severely reduced right ventricular (RV) function. Cardiopulmonary exercise test showed maximum oxygen consumption (VO 2 ) of 12 cc/kg/minute. His clinical presentation was consistent with idiopathic dilated cardiomyopathy of unknown etiology. An endomyocardial biopsy was not performed to rule out any treatable causes of heart failure, in keeping with current recommendations by the American Heart Association/American college of Cardiology (AHA/ACC).6 He was treated with aspirin and maximal tolerated doses of ACE receptor inhibitor, β-blocker, and a diuretic. An ICD (implantable cardioverterdefi brillator) was placed, and he was evaluated and placed on the cardiac transplant list. Due to his longstanding history of snoring, witnessed apneas, and excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] score of 17), he was evaluated for OSA in December 2008. Polysomnography, performed with a split-night protocol revealed an apnea-hypopnea index (AHI) of 68 with a SaO 2 nadir of 58%. Respiratory events were all obstructive in nature with no central apneas. Continuous positive airway pressure (CPAP) titration to a maximum pressure of 20 cm H 2 O was unsuccessful in controlling the obstruc...

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The Significance and Outcome of Continuous Positive Airway Pressure-Related Central Sleep Apnea During Split-Night Sleep Studies

Cited by 123 publications

References 25 publications

Air Leak during CPAP Titration as a Risk Factor for Central Apnea

Air Leak during CPAP Titration as a Risk Factor for Central Apnea

Central sleep apnea during continuous positive airway pressure therapy in obstructive sleep apnea patients: from the compliance to adaptation, maladaptation and reflexes

Treatment of Cardiomyopathy with PAP Therapy in a Patient with Severe Obstructive Sleep Apnea

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