Sleepcare Diagnostics, Christ Hospital, Cincinnati, OH 45040, USA.
J Clin Sleep Med. 2009 Jun 15;5(3):205-11.
Central sleep apnea (CSA) may occasionally occur in patients with obstructive sleep apnea during titration with a continuous positive airway pressure (CPAP) device.
To determine the prevalence and the natural history of CPAP-emergent CSA.
This is a retrospective study of 1286 patients with a diagnosis of OSAwho underwent titration with a positive airway device during a 1-year period. Patients were seen in consultation and underwent full-night attended polysomnography followed by full-night attended CPAP titration. Four weeks after CPAP therapy, patients returned to the clinic for follow-up, and objective adherence to CPAP was recorded. In patients who had CSA on CPAP, a second full-night attended CPAP titration was recommended.
Eighty-four of the 1286 patients developed a central apnea index (CAI) of 5 or greater per hour while on CPAP. The incidence of CSA varied from 3% to 10% monthly, with an overall incidence of 6.5%. Forty-two of the 84 patients returned for a second CPAP titration. In 33 patients, CSA was eliminated. In each of the remaining 9 patients, the CAI remained at 5 or greater per hour, with an average of 13 per hour. These patients characteristically had the most severe OSA, and 5 had a CAI of 5 or more per hour at baseline. Two of the 9 patients were on opioids
In this large retrospective study of 1286 patients with a diagnosis of OSA, 6.5% had CPAP-emergent or persistent CSA. However, CPAP-emergent CSA was generally transitory and was eliminated within 8 weeks after CPAP therapy. The prevalence of CPAP-persistent CSA was about 1.5%. Severity of OSA, a CAI of 5 or greater per hour, and use of opioids were potential risk factors.
在使用持续气道正压通气（CPAP）设备进行滴定的阻塞性睡眠呼吸暂停（OSA）患者中，偶尔会出现中枢性睡眠呼吸暂停（CSA）。
确定 CPAP 诱发 CSA 的患病率和自然史。
这是一项回顾性研究，纳入了 1286 例确诊为 OSA 并在 1 年内接受气道正压设备滴定的患者。患者在就诊时接受了整夜有监督的多导睡眠图检查，然后进行了整夜有监督的 CPAP 滴定。CPAP 治疗 4 周后，患者返回诊所进行随访，并记录客观的 CPAP 依从性。在 CPAP 上出现 CSA 的患者，建议进行第二次整夜有监督的 CPAP 滴定。
在接受 CPAP 的 1286 例患者中，有 84 例患者的中枢性呼吸暂停指数（CAI）每小时达到或超过 5 次。CSA 的发生率为每月 3%至 10%，总体发生率为 6.5%。84 例患者中有 42 例返回进行第二次 CPAP 滴定。在 33 例患者中，CSA 得到了消除。在其余 9 例患者中，CAI 仍保持在每小时 5 次或更高，平均为每小时 13 次。这些患者的 OSA 最严重，其中 5 例患者在基线时有每小时 5 次或更多的 CAI。这 9 例患者中有 2 例正在使用阿片类药物。
在这项对 1286 例确诊为 OSA 的患者进行的大型回顾性研究中，有 6.5%的患者在接受 CPAP 治疗时出现或持续存在 CSA。然而，CPAP 诱发的 CSA 通常是短暂的，并在 CPAP 治疗后 8 周内得到消除。CPAP 持续 CSA 的患病率约为 1.5%。OSA 的严重程度、每小时 CAI 为 5 次或更高以及使用阿片类药物是潜在的危险因素。
