Moving beyond empiric continuous positive airway pressure (CPAP) trials for central sleep apnea: a multi-modality titration study |
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Authors: | Tomasz J Kuzniar Jason M Golbin Timothy I Morgenthaler |
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Institution: | (1) Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA;(2) Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA;(3) Present address: Division of Pulmonary and Critical Care, Evanston Northwestern Healthcare, Evanston, IL, USA |
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Abstract: | There is no universally accepted method to determine effective therapy for central sleep apnea (CSA). Continuous positive
airway pressure (CPAP) applied acutely most often does not eliminate apneas and hypopneas. We hypothesized that the application
of two or more therapeutic modalities after the diagnostic phase of polysomnography, a multi-modality titration study (MMTS),
would identify a successful CSA treatment more often than a standard split-night study (SNS) and obviate the need for additional
polysomnograms to determine a successful therapy. We retrospectively analyzed polysomnograms of patients diagnosed with CSA
at our Sleep Disorders Center. We defined a therapy trial that resulted in an apnea–hypopnea index < 10 with at least one
treatment modality as a therapeutic success. One hundred fifteen patients with CSA were studied. Sixty-six patients (57.4%)
underwent a SNS, and 49 patients (42.6%) underwent a MMTS. SNS yielded only 8/66 (12.1%) successes on the first night, whereas
a MMTS yielded 19/49 (38.8%) successes (p = 0.001, two-tailed Fishers exact). Patients who underwent a SNS eventually had similar rate of success as patients studied
with MMTS (60.6 vs 63.3%, NS), but required more testing. Adaptive servo-ventilation was the most successful modality tested,
yielding 36/46 (78.3%) successes. Trials of additional modalities following a failed trial of CPAP often produce a successful
option that may guide therapy in patients with CSA. This approach may lead to establishing the diagnosis and treatment plans
faster, while reducing unnecessary testing. |
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Keywords: | Central sleep apnea Positive-pressure respiration Ventilatory support Oxygen inhalation therapy Polysomnography Split-night study |
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