• Research

Trajectories of Emergent Central Sleep Apnea during Continuous Positive Airway Pressure Therapy

Liu D, Armitstead J, Benjafield A, Shao S, Malhotra A, Cistulli PA, Pepin JL, Woehrle H. CHEST (2017), doi: 10.1016/j.chest.2017.06.010

BACKGROUND Emergence of central sleep apnea (CSA) during positive airway pressure (PAP) therapy has been observed clinically in about 10% of OSA titration studies. This study assessed a PAP database to investigate trajectories of treatment-emergent CSA during continuous PAP (CPAP) therapy.

METHODS US telemonitoring device data were analyzed for the presence/absence of emergent CSA at baseline (Week 1) and Week 13. Defined groups were: obstructive sleep apnea (OSA; average central apnea index [CAI] <5/hour in Week 1, <5/hour in Week 13); transient CSA (CAI >5/hour in Week 1, <5/hour in Week 13); persistent CSA (CAI >5/hour in Week 1, >5/hour in Week 13); emergent CSA (CAI <5/hour in Week 1, >5/hour in Week 13).

RESULTS 133,006 patients used CPAP for >90 days and had >1 day with use of >1 hour 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 versus without treatment-emergent CSA were older, had higher residual AHI and CAI at Week 13, and more leaks (all p<0.001). Patients with any treatment-emergent CSA were at higher risk of therapy termination versus those who did not develop CSA (all p<0.001).

CONCLUSIONS Our 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.

Published on August 23, 2018