Treatment-emergent central sleep apnea resolves with lower inspiratory pressure.

Autor:	Noah WH; Sleep Centers of Middle Tennessee, Murfreesboro,TN., Messineo L; Division of Sleep and Circadian Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA., Hete B; Sleep Centers of Middle Tennessee, Murfreesboro,TN., Thompson E; Sleep Centers of Middle Tennessee, Murfreesboro,TN., White DP; Division of Sleep and Circadian Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA., Farney RJ; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT., Sundar KM; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
Jazyk:	angličtina
Zdroj:	Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [J Clin Sleep Med] 2024 Dec 10. Date of Electronic Publication: 2024 Dec 10.
DOI:	10.5664/jcsm.11492
Abstrakt:	Study Objectives: Treatment emergent central sleep apnea (TECSA) is an important problem during therapy with continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA). Here we tested a device designed to improve CPAP comfort through reducing IPAP ( V ˙ -Com) to determine if such a reduction in IPAP could eliminate central apneas in patients with TECSA. Since increasing tidal volume (potentially via IPAP increments) has been suggested as a possible mechanism contributing to TECSA onset, our hypothesis was that reducing IPAP would yield a drop in the central apnea index (CAI). Methods: The addition of a known resistance ( V ˙ -Com device) that reduces IPAP was implemented into the CPAP circuit during the second half of CPAP titrations in a cohort of community-dwelling patients who developed TECSA during a split-night CPAP titration. CAI was quantified from the sleep periods without and with V ˙ -Com in place. Results: 1613 patients underwent CPAP titration with 19 of them developing TECSA during the titration. The addition of V ˙ -Com resulted in complete resolution of TECSA in all patients with adequate sleep data under all conditions (N=13), yielding a significant reduction in the CAI (17.3 ± 11.0 vs. 1.5 ± 1.7 events/h without and with V ˙ -Com, respectively, P<0.001). Conclusions: V ˙ -Com virtually resolved all instances of TECSA, suggesting that reducing IPAP could be an effective strategy for managing the occurrence of central respiratory events in OSA patients using CPAP. (© 2024 American Academy of Sleep Medicine.)
Databáze:	MEDLINE
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