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Prevalence and treatment of central sleep apnoea emerging after initiation of continuous positive airway pressure in patients with obstructive sleep apnoea without evidence of heart failure

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Abstract

Background

This study aimed to assess the prevalence of complex sleep apnoea (CompSA), defined as central sleep apnoea (CSA) emerging after the initiation of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA), in patients with normal brain natriuretic peptide (BNP) levels, along with assessing the prevalence of CSA persisting in such patients after the onset of CPAP therapy. We hypothesised that the prevalence of CompSA and persistent CSA after CPAP initiation would be low in patients with OSA and normal BNP levels.

Material and methods

Between April 2004 and July 2007, CPAP was initiated for all patients with OSA for two nights using a standardised protocol. The prevalence of CompSA syndrome (CompSAS) and persisting CSA [central apnoea index (CAI) >5/h and apnoea–hypopnoea index (AHI) >15/h with >50% central events during CPAP therapy] was prospectively assessed in patients with normal BNP levels. Patients with CompSAS or persisting CSA upon CPAP treatment received adaptive servoventilation (ASV).

Results

Of 1,776 patients with OSA receiving CPAP, 28 patients (1.57%) had CSA at the time of CPAP therapy and normal BNP levels. Additionally, 10 patients had CompSAS (0.56%) and 18 patients (1.01%) had persisting CSA. In patients with CompSA or persisting CSA, the AHI was significantly lower with CPAP therapy than at the time of diagnosis (34 ± 15/h vs. 47 ± 20/h, p = 0.005). The CAI increased from 10 ± 10/h to 18/h ± 13/h (p = 0.009) upon initiation of CPAP therapy. ASV reduced the AHI to 6 ± 12/h (p < 0.001) during the first night of use.

Conclusion

The prevalence of CompSA or persisting CSA in patients with OSA and normal BNP levels who are receiving CPAP therapy is low (1.57%). ASV is an effective treatment for these patients.

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Conflict of interest

Dr. P. Litterst reports that no significant conflicts of interest exist with any companies/organisations whose products or services are discussed in this article. There was no financial support for the study itself from any company. Michael Westhoff and Michael Arzt have received lecture fees from Respironics and Resmed, Germany; Michael Arzt has received unrestricted grant support from Resmed, Germany and grant support from the German Foundation for Cardiac Research (Deutsche Stiftung für Herzforschung).

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Authors and Affiliations

  1. Department of Pulmonary, Critical Care and Sleep Medicine, Hemer Lung Clinic, Theo-Funccius-Str. 1, 58675, Hemer, Germany

    Michael Westhoff & Patric Litterst

  2. Center for Sleep Medicine, Department of Internal Medicine II, Division of Respirology, University of Regensburg, Regensburg, Germany

    Michael Arzt

  3. Lungenklinik Hemer, Theo-Funccius-Str. 1, 58675, Hemer, Germany

    Michael Westhoff

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  1. Michael Westhoff
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  2. Michael Arzt
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  3. Patric Litterst
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Correspondence to Michael Westhoff.

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Westhoff, M., Arzt, M. & Litterst, P. Prevalence and treatment of central sleep apnoea emerging after initiation of continuous positive airway pressure in patients with obstructive sleep apnoea without evidence of heart failure. Sleep Breath 16, 71–78 (2012). https://doi.org/10.1007/s11325-011-0486-0

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  • DOI: https://doi.org/10.1007/s11325-011-0486-0

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