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The Significance and Outcome of CPAP Related Central Sleep Apnea During Split Night Sleep Studies

¹University of Oklahoma Health Sciences Center, Oklahoma City, OK ²University of Arkansas for Medical Sciences, Little Rock, AR

Tarek-Dernaika{at}ouhsc.edu

Abstract

ObjectiveTo determine whether central sleep apnea (CSA) occurring during CPAP titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF) and whether these events will improve with CPAP therapy.

DesignCross sectional analysis of patients with suspected sleep related breathing disorders referred for a split night polysomnography (PSG).

Patients and methodsForty-two OSA patients with and without CPAP related CSA were analyzed. All CSA patients (n=21) and controls (n=21) had echocardiography, pulmonary function tests (PFTs) and arterial blood gas (ABG). Repeat PSG on CPAP was obtained 2-3 months after adequate CPAP therapy in CSA group patients.

ResultsDemographics, Epworth Sleepiness Scale, PFTs, ABG and baseline diagnostic PSG were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in CSA group vs. controls. 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 controls. Twelve out of 14 patients (92%) in the CSA group demonstrated complete or near complete resolution of CSA events on follow-up PSG and showed improvement in SE, WASO and total arousals compared to their baseline study.

ConclusionsCSA 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 • CPAP • obstructive sleep apnea • therapy • heart failure • regulation of respiration • sleep disorders