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. 2017 Oct;152(4):751-760.
doi: 10.1016/j.chest.2017.06.010. Epub 2017 Jun 16.

Trajectories of Emergent Central Sleep Apnea During CPAP Therapy

Dongquan Liu  1 , Jeff Armitstead  2 , Adam Benjafield  2 , Shiyun Shao  1 , Atul Malhotra  3 , Peter A Cistulli  4 , Jean-Louis Pepin  5 , Holger Woehrle  6
Affiliations

Trajectories of Emergent Central Sleep Apnea During CPAP Therapy

Dongquan Liu et al. Chest. 2017 Oct.

Abstract

Background: The 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.

Methods: U.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).

Results: Patients (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).

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.

Keywords: CPAP; central sleep apnea; telemonitoring.

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Figures

Figure 1
Figure 1
Flow diagram. AHI = apnea-hypopnea index; ASV = adaptive servo-ventilation; CAI = central apnea index. aInvalid data entry = age implausible (n = 497), or received data and session date not synchronized (n = 46).
Figure 2
Figure 2
Residual (A) apnea-hypopnea index, (B) central apnea index, (C) obstructive apnea index, and (D) hypopnea index over time in patient subgroups during continuous positive airway pressure therapy. CSA = central sleep apnea; HI = hypopnea index; OAI = obstructive apnea index. See Figure 1 legend for expansion of other abbreviations.
Figure 3
Figure 3
Forest plot showing risk of therapy termination in the various patient subgroups. LPS = liters per second. See Figure 2 legend for expansion of other abbreviation.
Figure 4
Figure 4
Multivariate Cox model survival curve for continued use of CPAP after 90 days. IQR = interquartile range. See Figure 2 legend for expansion of other abbreviation.
Figure 5
Figure 5
Multivariate Cox model survival curve for continued use of CPAP after 90 days in the post hoc analysis (patients with baseline apnea-hypopnea index ≥ 15/h). See Figure 2 and 4 legends for expansion of abbreviations.
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References

    1. Westhoff M., Arzt M., Litterst P. Prevalence and treatment of central sleep apnoea emerging after initiation of continuous positive airway pressure in patients with obstructive sleep apnoea without evidence of heart failure. Sleep Breath. 2012;16(1):71–78. - PubMed
    1. American Academy of Sleep Medicine . 3rd ed. American Academy of Sleep Medicine; Darien, IL: 2014. International Classification of Sleep Disorders.
    1. Randerath W., Verbraecken J., Andreas S. Definition, discrimination, diagnosis and treatment of central breathing disorders during sleep. Eur Respir J. 2017;49(1):1600959. - PubMed
    1. Verbraecken J. Complex sleep apnoea syndrome. Breathe. 2013;9(5):373–380.
    1. Javaheri S., Smith J., Chung E. The prevalence and natural history of complex sleep apnea. J Clin Sleep Med. 2009;5(3):205–211. - PMC - PubMed

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