Liu Dongquan, Armitstead Jeff, Benjafield Adam, Shao Shiyun, Malhotra Atul, Cistulli Peter A, Pepin Jean-Louis, Woehrle Holger
ResMed Science Center, Singapore.
ResMed Science Center, Sydney, Australia.
Chest. 2017 Oct;152(4):751-760. doi: 10.1016/j.chest.2017.06.010. Epub 2017 Jun 16.
The emergence of central sleep apnea (CSA) during positive airway pressure (PAP) therapy has been observed clinically in approximately 10% of obstructive sleep apnea titration studies. This study assessed a PAP database to investigate trajectories of treatment-emergent CSA during continuous PAP (CPAP) therapy.
U.S. telemonitoring device data were analyzed for the presence/absence of emergent CSA at baseline (week 1) and week 13. Defined groups were as follows: obstructive sleep apnea (average central apnea index [CAI] < 5/h in week 1, < 5/h in week 13); transient CSA (CAI ≥ 5/h in week 1, < 5/h in week 13); persistent CSA (CAI ≥ 5/h in week 1, ≥ 5/h in week 13); emergent CSA (CAI < 5/h in week 1, ≥ 5/h in week 13).
Patients (133,006) used CPAP for ≥ 90 days and had ≥ 1 day with use of ≥ 1 h in week 1 and week 13. The proportion of patients with CSA in week 1 or week 13 was 3.5%; of these, CSA was transient, persistent, or emergent in 55.1%, 25.2%, and 19.7%, respectively. Patients with vs without treatment-emergent CSA were older, had higher residual apnea-hypopnea index and CAI at week 13, and more leaks (all P < .001). Patients with any treatment-emergent CSA were at higher risk of therapy termination vs those who did not develop CSA (all P < .001).
Our study identified a variety of CSA trajectories during CPAP therapy, identifying several different clinical phenotypes. Identification of treatment-emergent CSA by telemonitoring could facilitate early intervention to reduce the risk of therapy discontinuation and shift to more efficient ventilator modalities.
在大约10%的阻塞性睡眠呼吸暂停滴定研究中，临床上已观察到在气道正压通气（PAP）治疗期间出现中枢性睡眠呼吸暂停（CSA）。本研究评估了一个PAP数据库，以调查持续气道正压通气（CPAP）治疗期间治疗性CSA的发展轨迹。
分析美国远程监测设备数据，以确定在基线（第1周）和第13周时是否存在CSA。定义的组如下：阻塞性睡眠呼吸暂停（第1周平均中枢性呼吸暂停指数[CAI]<5次/小时，第13周<5次/小时）；短暂性CSA（第1周CAI≥5次/小时，第13周<5次/小时）；持续性CSA（第1周CAI≥5次/小时，第13周≥5次/小时）；新发CSA（第1周CAI<5次/小时，第13周≥5次/小时）。
患者（133,006例）使用CPAP≥90天，且在第1周和第13周有≥1天使用≥1小时。第1周或第13周有CSA的患者比例为3.5%；其中，CSA为短暂性、持续性或新发的分别占55.1%、25.2%和19.7%。有治疗性CSA的患者与无治疗性CSA的患者相比，年龄更大，第13周时残余呼吸暂停低通气指数和CAI更高，漏气更多（所有P<.001）。与未发生CSA的患者相比，任何有治疗性CSA的患者治疗终止风险更高（所有P<.001）。
我们的研究确定了CPAP治疗期间多种CSA发展轨迹，识别出几种不同的临床表型。通过远程监测识别治疗性CSA有助于早期干预，以降低治疗中断风险并转向更有效的通气模式。
