Skip to main content

Advertisement

SpringerLink
Log in

The prevalence and polysomnographic characteristics of treatment-emergent central sleep apnea with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

To investigate the prevalence of treatment-emergent central sleep apnea (TECSA) in individuals with obstructive sleep apnea syndrome (OSAS) during continuous positive airway pressure (CPAP) titration and assess their polysomnographic characteristics.

Methods

A total of 116 patients with OSAS who underwent full-night CPAP titration at the Sleep Laboratory of Adana City Research and Education Hospital from September 2017 to January 2018 were recruited for the study. The patients’ polysomnographic data related to respiratory events and sleep stages were reviewed in a retrospective manner.

Results

While on CPAP titration, 20 of the 116 patients developed central sleep apnea (CSA). The prevalence of TECSA in the patients with OSAS was 17.2%, being separately determined as 16.3% and 2.2% for the male and female patients, respectively. In the baseline PSG, the groups did not statistically significantly differ in relation to the apnea hypopnea index (AHI), central apnea index (CAI), arousal index (AI), or oxygen desaturation index (ODI). However, the TECSA group had a significantly higher mean oxygen saturation value compared to the non-TECSA group (p = 0.01). The total AHI, CAI, and AI values of the TECSA group were significantly higher during the whole CPAP titration compared to the non-TECSA group. No significant difference was observed in the comparison of the two groups in relation to the titration pressure and ODI.

Conclusion

TECSA is a phenomenon that can occur with obstructive sleep apnea treatment and mostly regress spontaneously following appropriate CPAP treatment. TECSA is observed at different rates of prevalence. In this study, the prevalence of TECSA was higher than previously reported.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Due to privacy and ethical concerns, neither the data nor its source code can be made available to the public.

References

  1. Sateia MJ (2014) International classification of sleep disorders-third edition: highlights and modifications. Chest 146(5):1387–1394. https://doi.org/10.1378/chest.14-0970

    Article  PubMed  Google Scholar 

  2. Ruehland WR, Rochford PD, O’Donoghue FJ, Pierce RJ, Singh P, Thornton AT (2009) The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 32(2):150–157. https://doi.org/10.1093/sleep/32.2.150

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bradley TD, Phillipson EA (1992) Central sleep apnea. Clin Chest Med 13(3):493–505

    Article  CAS  PubMed  Google Scholar 

  4. Rana AM, Sankari A (2023) Central sleep apnea. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from https://www.ncbi.nlm.nih.gov/books/NBK578199/

  5. Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T et al (2017) Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J 49(1):1600959. https://doi.org/10.1183/13993003.00959-2016

    Article  PubMed  Google Scholar 

  6. Liu D, Armitstead J, Benjafield A, Shao S, Malhotra A, Cistulli PA et al (2017) Trajectories of emergent central sleep apnea during CPAP therapy. Chest 152(4):751–760

    Article  PubMed  PubMed Central  Google Scholar 

  7. Selim B, Ramar K (2021) Sleep-related breathing disorders: when CPAP is not enough. Neurotherapeutics 18(1):81–90. https://doi.org/10.1007/s13311-020-00955-x

    Article  PubMed  Google Scholar 

  8. Zhang J, Wang L, Guo HJ, Wang Y, Cao J, Chen BY (2020) Treatment-emergent central sleep apnea: a unique sleep-disordered breathing. Chin Med J (Engl) 133(22):2721–2730. https://doi.org/10.1097/CM9.0000000000001125

    Article  CAS  PubMed  Google Scholar 

  9. Gay PC (2008) Complex sleep apnea: it really is a disease. J Clin Sleep Med 4(5):403–5

    Article  PubMed  PubMed Central  Google Scholar 

  10. Malhotra A, Bertisch S, Wellman A (2008) Complex sleep apnea: it isn’t really a disease. J Clin Sleep Med 4(5):406–8

    Article  PubMed  PubMed Central  Google Scholar 

  11. Younes M, Ostrowski M, Thompson W, Leslie C, Shewchuk W (2001) Chemical control stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med 163:1181–1190. https://doi.org/10.1164/ajrccm.163.5.2007013

    Article  CAS  PubMed  Google Scholar 

  12. Salloum A, Rowley JA, Mateika JH, Chowdhuri S, Omran Q, Badr MS (2010) Increased propensity for central apnea in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure. Am J Respir Crit Care Med 181:189–193

    Article  PubMed  Google Scholar 

  13. Stanchina M, Robinson K, Corrao W, Donat W, Sands S, Malhotra A (2014) Clinical use of loop gain measures to determine continuous positive airway pressure efficacy in patients with complex sleep apnea. A pilot study. Ann Am Thorac Soc 12(9):1351–1357. https://doi.org/10.1513/AnnalsATS.201410-469BC

    Article  Google Scholar 

  14. Cassel W, Canisius S, Becker HF, Leistner S, Ploch T, Jerrentrup A et al (2011) A prospective polysomnographic study on the evolution of complex sleep apnoea. Eur Respir J 38(2):329–337. https://doi.org/10.1183/09031936.00162009

    Article  CAS  PubMed  Google Scholar 

  15. Nakazaki C, Noda A, Yasuda Y, Nakata S, Koike Y, Yasuma F et al (2012) Continuous positive airway pressure intolerance associated with elevated nasal resistance is possible mechanism of complex sleep apnea syndrome. Sleep Breath 16(3):747–752. https://doi.org/10.1007/s11325-011-0570-5

    Article  PubMed  Google Scholar 

  16. Kuźniar TJ, Morgenthaler TI (2008) Treatment of complex sleep apnea syndrome. Curr Treat Options Neurol 10(5):336–341. https://doi.org/10.1007/s11940-008-0036-7

    Article  PubMed  Google Scholar 

  17. Dernaika T, Tawk M, Nazir S, Younis W, Kinasewitz GT (2007) The significance and outcome of continuous positive airway pressure-related central sleep apnea during split-night sleep studies. Chest 132(1):81–87. https://doi.org/10.1378/chest.06-2562

    Article  PubMed  Google Scholar 

  18. Brown LK, Casey KR (2007) Complex sleep apnea: the hedgehog and the fox. Curr Opin Pulm Med 13(6):473–478. https://doi.org/10.1097/MCP.0b013e3282f1479b

    Article  PubMed  Google Scholar 

  19. Montesi SB, Bakker JP, Macdonald M, Hueser L, Pittman S, White DP et al (2013) Leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med 9(11):1187–1191. https://doi.org/10.5664/jcsm.3166

    Article  PubMed  PubMed Central  Google Scholar 

  20. Morgenthaler TI, Kagramanov V, Hanak V, Decker PA (2006) Complex sleep apnea syndrome: is it a unique clinical syndrome? Sleep 29(9):1203–1209. https://doi.org/10.1093/sleep/29.9.1203

    Article  PubMed  Google Scholar 

  21. Javaheri S, Smith J, Chung E (2009) The prevalence and natural history of complex sleep apnea. J Clin Sleep Med 5(3):205–211

    Article  PubMed  PubMed Central  Google Scholar 

  22. Aurora RN, Chowdhuri S, Ramar K, Bista SR, Casey KR, Lamm CI et al (2012) The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep 35(1):17–40. https://doi.org/10.5665/sleep.1580

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C et al (2008) Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 4(2):157–71

    Article  PubMed  Google Scholar 

  24. Lehman S, Antic NA, Thompson C, Catcheside PG, Mercer J, McEvoy RD (2007) Central sleep apnea on commencement of continuous positive airway pressure in patients with a primary diagnosis of obstructive sleep apnea-hypopnea. J Clin Sleep Med 3(5):462–6

    Article  PubMed  PubMed Central  Google Scholar 

  25. Verbraecken J, Schoonis L, Verplancke B (2009) Prevalence of complex sleep apnea (CompSAS) during manual CPAP titration for obstructive sleep apnea. Eur Respir J 34(53):649s. https://doi.org/10.1183/20734735.042412

    Article  Google Scholar 

  26. Endo Y, Suzuki M, Inoue Y, Sato M, Namba K, Hasegawa M et al (2008) Prevalence of complex sleep apnea among Japanese patients with sleep apnea syndrome. Tohoku J Exp Med 15(4):349–354. https://doi.org/10.1620/tjem.215.349

    Article  Google Scholar 

  27. Thomas RJ, Terzano MG, Parrino L, Weiss JW (2004) Obstructive sleep-disordered breathing with a dominant cyclic alternating pattern–a recognizable polysomnographic variant with practical clinical implications. Sleep 27(2):229–234. https://doi.org/10.1093/sleep/27.2.229

    Article  PubMed  Google Scholar 

  28. Yaegashi H, Fujimoto K, Abe H, Orii K, Eda S, Kubo K (2009) Characteristics of Japanese patients with complex sleep apnea syndrome: a retrospective comparison with obstructive sleep apnea syndrome. Intern Med 48(6):427–432. https://doi.org/10.2169/internalmedicine.48.1459

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Adana City Research and Education Hospital, Adana, Turkey

    Sinem Berik Safçi

Authors
  1. Sinem Berik Safçi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sinem Berik Safçi.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants adhered to the ethical standards set by the institutional and/or national research committee (Adana Research and Education Hospital, Clinical Research Ethics Committee), as well as those specified by the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

Formal consent was not required for this type of study.

Conflict of interest

The author declares no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berik Safçi, S. The prevalence and polysomnographic characteristics of treatment-emergent central sleep apnea with obstructive sleep apnea. Sleep Breath (2024). https://doi.org/10.1007/s11325-024-02999-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11325-024-02999-1

Keywords

Search

Navigation