The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses

Aurora, R. Nisha; Chowdhuri, Susmita; Ramar, Kannan; Bista, Sabin R.; Casey, Kenneth R.; Lamm, Carin; Kristo, David A.; Mallea, Jorge M.; Rowley, James A.; R, Zák; Tracy, Sharon L.; Thomas, Sherene M.

doi:10.5665/sleep.1580

Cited by 319 publications

(208 citation statements)

References 101 publications

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“…Recent reviews on the evaluation and management of CSA and sleep-related hypoventilation have been published separately by the AASM. [3][4][5] The prevalence of OSA varies significantly based on the population being studied and how OSA is defined (e.g., testing methodology, scoring criteria used, and apnea-hypopnea index [AHI] threshold). The prevalence of OSA has been estimated to be 14% of men and 5% of women, in a population-based study utilizing an AHI cutoff of ≥ 5 events/h (hypopneas associated with 4% oxygen desaturations) combined with clinical symptoms to define OSA.…”

Section: Backg Roundmentioning

confidence: 99%

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

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2,030

1,498

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Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements:Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations:1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG) 2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG) 3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG) 4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG) 5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protoc...

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Section: Backg Roundmentioning

confidence: 99%

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

Self Cite

2,030

1,498

View full text Add to dashboard Cite

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“…It is possible that central sleep apnoea, common in patients with heart failure and ischaemic heart disease 22 , 23 contributed to significant respiratory events identified on overnight sleep monitoring. Central sleep apnoea is characterised by pauses in breathing with no apparent occlusion of the airway and there are no published data on its impact on surgical outcomes though it has been implicated in adverse outcomes for patients with cardiac disease 24 . Further research is needed to assess its impact on postoperative outcomes in patients undergoing surgical procedures.…”

Section: Postoperative Outcomes In Patients With Osa Undergoing Cardimentioning

confidence: 99%

Obstructive sleep apnoea in patients undergoing cardiac surgery: Screening, postoperative outcomes and perioperative care

Mason¹

2018

J Cardiol and Cardiovasc Sciences

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Obstructive sleep apnoea (OSA) is common and high prevalence has been described amongst patients undergoing cardiac revascularisation surgery. An excess of postoperative complications has been reported in patients with untreated Obstructive Sleep Apnoea (OSA) following surgical procedures, including those undergoing cardiac surgery. This has led some clinicians towards pre-operative screening for OSA though the best screening methodology has not yet been established. Moreover, the effect of screening and of treatment for OSA on surgical outcomes remains unknown. Does current evidence justify screening and treating patients before they present for surgery? Is this leading to potential delay in surgery whilst awaiting sleep diagnostics and commencing the treatment? This review article will examine the available evidence base and endeavour to answer these questions and identify implications for future research. OSA and cardiovascular diseaseSleep Disordered Breathing is a term used to cover a range of breathing events encountered during sleep and includes obstructive sleep apnoea (OSA), central sleep apnoea, Cheyne-Stokes respiration and respiratory effort related arousals. OSA is the most common form of sleep disordered breathing. OSA is common 1 and the reported prevalence has increased in the last two decades 1 with the new data reported mainly in European population of adults 40-85 years old showing that at least mild OSA (apnoea-hypopnoea index ≥5) was present in 84% of men and 61% of women and at least moderate disease (apnoea-hypopnoea index ≥15) was present in 50% of men and 23 % of women 2 . OSA and cardiac disease share some common risk factors and in patients undergoing coronary artery bypass graft (CABG) procedures reported prevalence is high, ranging between 41 and 87% 3-5 .High proportions of patients may present for surgery without a previous diagnosis of OSA 6,7 and may be at risk of worse postoperative outcomes 8 . In patients with moderate to severe OSA syndrome Continuous Positive Airway Pressure (CPAP) is the conventional treatment with established clinical and cost effectiveness 9 but its effect on cardiovascular outcomes has not been confirmed. A recent, large, randomised controlled trial of adults with moderate to severe OSA and pre-existing cardiovascular disease showed that the use of CPAP had no significant effect on the prevention of recurrent serious cardiovascular events 10 . It is possible that patients with compliance exceeding 4h/night may

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“…Most previous studies and published guidelines have relied on intermediate outcomes, such as AHI, ejection fraction, or quality of life metrics. 1,2 In contrast, this study tested a robust composite outcome combining death, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening heart failure. Casting a wide net strengthened the results by capturing myriad relevant outcome measures.…”

Section: Co M M Entarymentioning

confidence: 99%

Adaptive Servo-Ventilation and Central Apnea Associated with Systolic Heart Failure

Shafazand

Badr

2016

Journal of Clinical Sleep Medicine

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In individuals with symptomatic congestive heart failure (left ventricular ejection fraction ≤ 45%) and predominately central sleep apnea, does treatment of the sleep apnea with adaptive servo-ventilation (ASV), in addition to guideline based medical treatment change time to first event (composite of first event of death from any cause, lifesaving cardiovascular intervention [cardiac transplantation, implantation of a ventricular assist device, resuscitation after sudden cardiac arrest, or appropriate lifesaving shock], or unplanned hospitalization for worsening heart failure)? Methods DesignMulti-center, randomized, controlled trial; clinicaltrials.gov identifier: NCT00733343. AllocationRandomization was conducted by a centralized computer system. Allocation was stratified by country. The randomization sequence was concealed. BlindingThe investigators and participants were not blinded to study arm assignment. The primary outcome measurements were blinded. Follow-up periodThis was an event driven analysis. Participants were recruited over a period of 60 months with a total of 2-year follow-up until the target 651 observed events was reached. SettingPatients were recruited from each investigator's network of sleep and cardiology practices.

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The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses

Cited by 319 publications

References 101 publications

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Obstructive sleep apnoea in patients undergoing cardiac surgery: Screening, postoperative outcomes and perioperative care

Adaptive Servo-Ventilation and Central Apnea Associated with Systolic Heart Failure

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