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The Significance and Outcome of Continuous Positive Airway Pressure-Related Central Sleep Apnea During Split-Night Sleep Studies^*

^* From the University of Oklahoma Health Sciences Center (Drs. Dernaika, Tawk, Younis, and Kinasewitz), Oklahoma City, OK; and University of Arkansas for Medical Sciences (Dr. Nazir), Little Rock, AR.

Correspondence to: Tarek Dernaika, MD, 920 Stanton L. Young Blvd, WP 1310, Oklahoma City, OK 73104; e-mail: Tarek-Dernaika{at}ouhsc.edu

Abstract

Objective: To determine whether central sleep apnea (CSA) occurring during continuous positive airway pressure (CPAP) titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF), and whether these events will improve with CPAP therapy.

Design: Cross-sectional analysis of patients with suspected sleep-related breathing disorders referred for split-night polysomnography

Patients and methods: Forty-two OSA patients with and without CPAP-related CSA were analyzed. All CSA patients (n = 21) and control subjects (n = 21) underwent echocardiography, pulmonary function testing, and arterial blood gas (ABG) analysis. Repeat polysomnography with CPAP was performed 2 to 3 months after adequate CPAP therapy in CSA group patients.

Results: Demographic, Epworth sleepiness scale, pulmonary function test, ABG, and baseline diagnostic polysomnography findings were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in the CSA group vs the control group. CSA patients had decreased sleep efficiency (SE), increased sleep stage 1 percentage, sleep stages shift, wake time after sleep onset (WASO), and total arousals compared to control subjects. Twelve of 14 patients (92%) in the CSA group demonstrated complete or near-complete resolution of CSA events on follow-up polysomnography and showed improvement in SE, WASO, and total arousals compared to their baseline study.

Conclusions: CSA events occurring during CPAP titration are transient and self-limited. They may be precipitated by the sleep fragmentation associated with initial CPAP titration and are not associated with an increased prevalence of occult CHF compared to OSA patients without CPAP-related CSA.

Key Words: central sleep apnea • Cheyne-Stokes respiration • continuous positive airway pressure • heart failure • obstructive sleep apnea • regulation of respiration • sleep-disorders therapy