Author(s): Javaheri S, Smith J, Chung E
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Abstract 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.
This article was published in J Clin Sleep Med
and referenced in Journal of Pulmonary & Respiratory Medicine