John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI.
John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI.
Chest. 2021 Jun;159(6):2449-2457. doi: 10.1016/j.chest.2021.01.036. Epub 2021 Jan 23.
The purpose of this review was to describe our management approach to patients with treatment-emergent central sleep apnea (TECSA). The emergence of central sleep apnea during positive airway pressure therapy occurs in approximately 8% of titration studies for OSA, and it has been associated with several demographic, clinical, and polysomnographic factors, as well as factors related to the titration study itself. TECSA shares similar pathophysiology with central sleep apnea. In fact, central and OSA pathophysiologic mechanisms are inextricably intertwined, with ventilatory instability and upper airway narrowing occurring in both entities. TECSA is a "dynamic" process, with spontaneous resolution with ongoing positive airway pressure therapy in most patients, persistence in some, or appearing de novo in a minority of patients. Management strategy for TECSA aims to eliminate abnormal respiratory events, stabilize sleep architecture, and improve the underlying contributing medical comorbidities. CPAP therapy remains a standard therapy for TECSA. Expectant management is appropriate given its transient nature in most cases, whereas select patients would benefit from an early switch to an alternative positive airway pressure modality. Other treatment options include supplemental oxygen and pharmacologic therapy.
本综述旨在描述我们对治疗中出现的中枢性睡眠呼吸暂停（TECSA）患者的管理方法。在大约 8%的 OSA 压力滴定研究中，正压通气治疗期间会出现中枢性睡眠呼吸暂停，它与多种人口统计学、临床和多导睡眠图因素以及与滴定研究本身相关的因素有关。TECSA 与中枢性睡眠呼吸暂停具有相似的病理生理学机制。事实上，中枢性和 OSA 病理生理机制是交织在一起的，在这两种情况下都会出现通气不稳定和上呼吸道狭窄。TECSA 是一个“动态”过程，大多数患者在持续正压通气治疗下会自发缓解，部分患者持续存在，少数患者会新出现。TECSA 的管理策略旨在消除异常呼吸事件，稳定睡眠结构，并改善潜在的合并症。CPAP 治疗仍然是 TECSA 的标准治疗方法。鉴于大多数情况下 TECSA 的短暂性，期待治疗是合适的，而对于一些特定患者，从早期转换为替代的正压通气模式可能会获益。其他治疗选择包括补充氧气和药物治疗。
