Mohan Arjun, Henderson Jennifer, Mador M Jeffery
Veterans Affairs Western NY Healthcare System, Buffalo, NY.
Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York-Buffalo, NY.
J Clin Sleep Med. 2016 Jan;12(1):137-8. doi: 10.5664/jcsm.5414.
The development of treatment emergent central sleep apnea (CSA) has been described after almost all obstructive sleep apnea (OSA) therapies. While the course of positive airway pressure (PAP) emergent CSA, is better established; little is known about the natural course of mandibular advancement device (MAD) emergent CSA. Previous reports failed to comment on its natural course or report treatment with advanced ventilator modes such as adaptive servoventilation. We describe spontaneous resolution of MAD emergent CSA in a patient with moderate OSA who refused PAP. We also highlight the need for follow up polysomnography (PSG) after maximal advancement with a MAD and the possible association between MAD emergent CSA and atrial fibrillation. The exact pathophysiology of this phenomenon remains unclear but may relate to high loop gain of the respiratory system resulting in ventilatory overshoot after treatment and atrial fibrillation associated increased susceptibility to periodic ventilation.
几乎所有阻塞性睡眠呼吸暂停（OSA）治疗后均有治疗性突发中枢性睡眠呼吸暂停（CSA）的报道。虽然气道正压通气（PAP）所致CSA的病程已较为明确，但对于下颌前移装置（MAD）所致CSA的自然病程知之甚少。既往报道未对其自然病程进行评论，也未报道采用如适应性伺服通气等高级通气模式进行治疗的情况。我们描述了1例拒绝使用PAP的中度OSA患者中MAD所致CSA的自发缓解情况。我们还强调了在使用MAD将下颌最大限度前移后进行随访多导睡眠图（PSG）检查的必要性，以及MAD所致CSA与心房颤动之间可能存在的关联。这一现象的确切病理生理学机制尚不清楚，但可能与呼吸系统的高环路增益有关，导致治疗后通气过冲以及心房颤动相关的周期性通气易感性增加。
