Treatment-emergent central sleep apnea
- Sairam Parthasarathy, MD
Sairam Parthasarathy, MD
- Associate Professor of Medicine
- University of Arizona
Treatment-emergent central sleep apnea (CSA), previously referred to as complex sleep apnea, is detected in approximately 5 to 15 percent of patients who undergo positive airway pressure (PAP) titration for obstructive sleep apnea (OSA). Treatment-emergent CSA is defined as the persistence or emergence of central apneas and hypopneas during the initiation of PAP therapy without a backup respiratory rate for obstructive OSA, despite significant resolution of obstructive respiratory events .
Alternative definitions of treatment-emergent CSA have been used [2-6], but they all share the presence of new or increased central apneas and hypopneas that prevent the apnea hypopnea index (AHI) from normalizing despite the disappearance of obstructive apneas and hypopneas.
The epidemiology, pathogenesis, clinical presentation, clinical findings, diagnostic criteria, and management of treatment-emergent CSA are reviewed here. The diagnosis and management of OSA and central sleep apnea are described separately. (See "Clinical presentation and diagnosis of obstructive sleep apnea in adults" and "Management of obstructive sleep apnea in adults" and "Central sleep apnea: Risk factors, clinical presentation, and diagnosis" and "Central sleep apnea: Treatment".)
PREVALENCE AND RISK FACTORS
Risk factors for treatment-emergent central sleep apnea (CSA) are not well understood, and there is wide variability in the reported incidence depending upon the study and the population. In a large prospective study, the prevalence during the first night with stable continuous positive airway pressure (CPAP) was 12 percent . Smaller studies have reported an incidence ranging from 5 to 20 percent. The incidence tends to be higher in studies using split-night versus full-night PAP titration.
Factors associated with an increased likelihood of treatment-emergent CSA in small studies include (table 1):
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- PREVALENCE AND RISK FACTORS
- CLINICAL FEATURES
- NATURAL HISTORY
- Expectant management with CPAP
- Alternative modes of ventilation
- - Adaptive servo-ventilation
- - BPAP with a backup respiratory rate
- Modes to avoid
- SUMMARY AND RECOMMENDATIONS