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Treatment-emergent central sleep apnea: a unique sleep-disordered breathing - PubMed

  • ️Wed Jan 01 2020

Review

Treatment-emergent central sleep apnea: a unique sleep-disordered breathing

Jing Zhang et al. Chin Med J (Engl). 2020.

Abstract

Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1

Schematic representation of potential pathophysiological mechanisms of treatment-emergent central sleep apnea in patients with obstructive sleep apnea. CHF: Congestive heart failure; CO2: Carbon dioxide; CPAP: Continuous positive airway pressure; CSA: Central sleep apnea; OSA: Obstructive sleep apnea; PaCO2: Partial pressure of carbon dioxide in arterial blood.

Figure 2
Figure 2

Flow diagram of treatment of treatment-emergent central sleep apnea in patients with obstructive sleep apnea. ASV: Adaptive servo-ventilation; BiPAP-S/T: Bilevel positive airway pressure-spontaneous/timed; CPAP: Continuous positive airway pressure; OSA: Obstructive sleep apnea; TECSA: Treatment-emergent central sleep apnea.

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