RATIONALE: Central sleep apnea (CSA) may occasionally occur in patients with obstructive sleep apnea during titration with a continuous positive airway pressure (CPAP) device. OBJECTIVES: To determine the prevalence and the natural history of CPAP-emergent CSA. METHODS: This is a retrospective study of 1286 patients with a diagnosis of OSAwho underwent titration with a positive airway device during a 1-year period. Patients were seen in consultation and underwent full-night attended polysomnography followed by full-night attended CPAP titration. Four weeks after CPAP therapy, patients returned to the clinic for follow-up, and objective adherence to CPAP was recorded. In patients who had CSA on CPAP, a second full-night attended CPAP titration was recommended. RESULTS: Eighty-four of the 1286 patients developed a central apnea index (CAI) of 5 or greater per hour while on CPAP. The incidence of CSA varied from 3% to 10% monthly, with an overall incidence of 6.5%. Forty-two of the 84 patients returned for a second CPAP titration. In 33 patients, CSA was eliminated. In each of the remaining 9 patients, the CAI remained at 5 or greater per hour, with an average of 13 per hour. These patients characteristically had the most severe OSA, and 5 had a CAI of 5 or more per hour at baseline. Two of the 9 patients were on opioids CONCLUSIONS: In this large retrospective study of 1286 patients with a diagnosis of OSA, 6.5% had CPAP-emergent or persistent CSA. However, CPAP-emergent CSA was generally transitory and was eliminated within 8 weeks after CPAP therapy. The prevalence of CPAP-persistent CSA was about 1.5%. Severity of OSA, a CAI of 5 or greater per hour, and use of opioids were potential risk factors.
RATIONALE: Central sleep apnea (CSA) may occasionally occur in patients with obstructive sleep apnea during titration with a continuous positive airway pressure (CPAP) device. OBJECTIVES: To determine the prevalence and the natural history of CPAP-emergent CSA. METHODS: This is a retrospective study of 1286 patients with a diagnosis of OSAwho underwent titration with a positive airway device during a 1-year period. Patients were seen in consultation and underwent full-night attended polysomnography followed by full-night attended CPAP titration. Four weeks after CPAP therapy, patients returned to the clinic for follow-up, and objective adherence to CPAP was recorded. In patients who had CSA on CPAP, a second full-night attended CPAP titration was recommended. RESULTS: Eighty-four of the 1286 patients developed a central apnea index (CAI) of 5 or greater per hour while on CPAP. The incidence of CSA varied from 3% to 10% monthly, with an overall incidence of 6.5%. Forty-two of the 84 patients returned for a second CPAP titration. In 33 patients, CSA was eliminated. In each of the remaining 9 patients, the CAI remained at 5 or greater per hour, with an average of 13 per hour. These patients characteristically had the most severe OSA, and 5 had a CAI of 5 or more per hour at baseline. Two of the 9 patients were on opioids CONCLUSIONS: In this large retrospective study of 1286 patients with a diagnosis of OSA, 6.5% had CPAP-emergent or persistent CSA. However, CPAP-emergent CSA was generally transitory and was eliminated within 8 weeks after CPAP therapy. The prevalence of CPAP-persistent CSA was about 1.5%. Severity of OSA, a CAI of 5 or greater per hour, and use of opioids were potential risk factors.
Authors: Hideaki Nakayama; Curtis A Smith; Joshua R Rodman; James B Skatrud; Jerome A Dempsey Journal: Am J Respir Crit Care Med Date: 2002-05-01 Impact factor: 21.405
Authors: Richard S T Leung; Matthias A Huber; Thomas Rogge; Nimrod Maimon; Kuo-Liang Chiu; T Douglas Bradley Journal: Sleep Date: 2005-12 Impact factor: 5.849
Authors: S Javaheri; T J Parker; L Wexler; S E Michaels; E Stanberry; H Nishyama; G A Roselle Journal: Ann Intern Med Date: 1995-04-01 Impact factor: 25.391
Authors: S Javaheri; T J Parker; J D Liming; W S Corbett; H Nishiyama; L Wexler; G A Roselle Journal: Circulation Date: 1998-06-02 Impact factor: 29.690
Authors: Bhavneesh K Sharma; Jessie P Bakker; David G McSharry; Akshay S Desai; Shahrokh Javaheri; Atul Malhotra Journal: Chest Date: 2012-11 Impact factor: 9.410