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. 2018 Apr-Jun;13(2):86-91.
doi: 10.4103/atm.ATM_321_17.

Natural history of treatment-emergent central sleep apnea on positive airway pressure: A systematic review

Gaurav Nigam  1 , Muhammad Riaz  2 , Edward T Chang  3 , Macario Camacho  3
Affiliations

Natural history of treatment-emergent central sleep apnea on positive airway pressure: A systematic review

Gaurav Nigam et al. Ann Thorac Med. 2018 Apr-Jun.

Abstract

Introduction: Treatment-emergent central sleep apnea (TECSA) is observed in some patients when they are treated with positive airway pressure (PAP) after significant resolution of the preexisting obstructive events in patients with obstructive sleep apnea. The objective of this study was to systematically review the literature for studies describing the natural history of TECSA.

Methods: PubMed, Medline, Scopus, Web of Science, and Cochran Library databases were searched through June 29, 2017.

Results: Five studies were identified that discussed the natural history of TECSA. TECSA developed in 3.5%-19.8% of PAP-treated patients. Treatment-persistent central sleep apnea (TPCSA), representing protracted periods of PAP therapy-related central apneas, was noted in 14.3%-46.2% of patients with TECSA. Delayed-TECSA (D-TECSA) represents an anomalous TECSA entity appearing weeks to months after initial PAP therapy. D-TECSA was observed in 0.7%-4.2% of OSA patients undergoing PAP treatment (after at least 1 month). In patients with TECSA, a higher apnea-hypopnea index (AHI) and central apnea index at their baseline study or a higher residual AHI at their titration study may be associated with an increased likelihood of conversion to TPCSA.

Conclusions: Overall, TECSA developed in 3.5%-19.8% of PAP-treated patients with OSA. The vast majority will experience complete resolution of central apneas over a few weeks to months. Unfortunately, about a third of patients with TECSA may continue to exhibit persistence of central sleep apnea on reevaluation. A small proportion may experience D-TECSA after few weeks to several months of initial exposure to PAP therapy.

Keywords: Apnea–hypopnea index; central sleep apnea; delayed-treatment-emergent central sleep apnea; obstructive sleep apnea; treatment-emergent central sleep apnea; treatment-persistent central sleep apnea.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Literature search methodology for studying natural history of treatment-emergent central sleep apnea
Figure 2
Figure 2
Schematic diagram showing natural history of treatment-emergent central sleep apnea
See this image and copyright information in PMC

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