Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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ORIGINAL ARTICLE
Year : 2018  |  Volume : 13  |  Issue : 2  |  Page : 86-91

Natural history of treatment-emergent central sleep apnea on positive airway pressure: A systematic review


1 Division of Sleep Medicine, Clay County Hospital, Flora, IL, USA
2 Division of Sleep Medicine, Astria Health Center, Grandview, WA, USA
3 Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, HI, USA

Correspondence Address:
Dr. Gaurav Nigam
Clay County Hospital, 911 Stacy Burk Drive, Flora, IL 62839
USA
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DOI: 10.4103/atm.ATM_321_17

PMID: 29675059

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INTRODUCTION: Treatment-emergent central sleep apnea (TECSA) is observed in some patients when they are treated with positive airway pressure (PAP) after significant resolution of the preexisting obstructive events in patients with obstructive sleep apnea. The objective of this study was to systematically review the literature for studies describing the natural history of TECSA. METHODS: PubMed, Medline, Scopus, Web of Science, and Cochran Library databases were searched through June 29, 2017. RESULTS: Five studies were identified that discussed the natural history of TECSA. TECSA developed in 3.5%–19.8% of PAP-treated patients. Treatment-persistent central sleep apnea (TPCSA), representing protracted periods of PAP therapy-related central apneas, was noted in 14.3%–46.2% of patients with TECSA. Delayed-TECSA (D-TECSA) represents an anomalous TECSA entity appearing weeks to months after initial PAP therapy. D-TECSA was observed in 0.7%–4.2% of OSA patients undergoing PAP treatment (after at least 1 month). In patients with TECSA, a higher apnea–hypopnea index (AHI) and central apnea index at their baseline study or a higher residual AHI at their titration study may be associated with an increased likelihood of conversion to TPCSA. CONCLUSIONS: Overall, TECSA developed in 3.5%–19.8% of PAP-treated patients with OSA. The vast majority will experience complete resolution of central apneas over a few weeks to months. Unfortunately, about a third of patients with TECSA may continue to exhibit persistence of central sleep apnea on reevaluation. A small proportion may experience D-TECSA after few weeks to several months of initial exposure to PAP therapy.


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