Trajectories of Emergent Central Sleep Apnea During CPAP Therapy

Abstract

BackgroundThe emergence of central sleep apnea (CSA) during positive airway pressure (PAP) therapy has been observed clinically in approximately 10% of obstructive sleep apnea titration studies. This study assessed a PAP database to investigate trajectories of treatment-emergent CSA during continuous PAP (CPAP) therapy.MethodsU.S. telemonitoring device data were analyzed for the presence/absence of emergent CSA at baseline (week 1) and week 13. Defined groups were as follows: obstructive sleep apnea (average central apnea index [CAI] < 5/h in week 1, < 5/h in week 13); transient CSA (CAI ≥ 5/h in week 1, < 5/h in week 13); persistent CSA (CAI ≥ 5/h in week 1, ≥ 5/h in week 13); emergent CSA (CAI < 5/h in week 1, ≥ 5/h in week 13).ResultsPatients (133,006) used CPAP for ≥ 90 days and had ≥ 1 day with use of ≥ 1 h in week 1 and week 13. The proportion of patients with CSA in week 1 or week 13 was 3.5%; of these, CSA was transient, persistent, or emergent in 55.1%, 25.2%, and 19.7%, respectively. Patients with vs without treatment-emergent CSA were older, had higher residual apnea-hypopnea index and CAI at week 13, and more leaks (all P < .001). Patients with any treatment-emergent CSA were at higher risk of therapy termination vs those who did not develop CSA (all P < .001).ConclusionsOur study identified a variety of CSA trajectories during CPAP therapy, identifying several different clinical phenotypes. Identification of treatment-emergent CSA by telemonitoring could facilitate early intervention to reduce the risk of therapy discontinuation and shift to more efficient ventilator modalities.

Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

“…However, the aggregate point prevalence of TECSA was 8% [4]. This wide variation in prevalence can be ascribed to the characteristics of the study groups such as patient demographics, body mass index (BMI), gender, age and comorbidities, and factors related to the diagnostic procedure such as split-night titration and titration in the supine position [5].…”

“…Additionally, patients with TECSA have lower adherence to PAP therapy and are more likely to terminate therapy [5].…”

“…A recent large study that followed patients with OSA for 90 days after the initiation of CPAP, defined the following risk factors for the development of TECSA; older age, higher residual apnea-hypopnea index (AHI) and central apnea index (CAI), and higher leak [5]. A systematic review identified the flowing factors at the time of diagnostic study as predictors of subsequent development of TECSA during titration studies; male sex, older age, low BMI, higher baseline AHI, CAI, use of narcotics, arousal index at baseline, use of BPAP, high PAP levels, and the presence of heart failure or ischemic heart disease [4].…”

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

“…A recent work by Liu et al (19) explored trajectories of treatment-emergent central sleep apnea (CSA) during CPAP therapy, obtained through the analysis of a CPAP database of 133,006 patients from the U.S. telemonitoring device data-AirView, who used CPAP for ≥90 days and had ≥1 day with use of ≥1 h in week 1 and week 13. After the analysis of the presence/absence of emergent CSA at baseline (week 1) and week 13, four groups were defined as follows: OSA (average CAI <5/h in week 1, <5/h in week 13); transient CSA (CAI ≥5/h in week 1, <5/h in week 13); persistent CSA (CAI ≥5/h in week 1, ≥5/h in week 13); emergent CSA (CAI <5/h in week 1, ≥5/h in week 13).…”

Emergent central sleep apnea during CPAP therapy-clinical implications

“…In a recent study, a different approach to examining CPAP emergent CSA was employed (6). These authors queried a large administrative commercial data base (Resmed) to better understand the prevalence of this condition.…”