FIRST NIGHT FREQUENCY OF CENTRAL SLEEP APNEA FOLLOWING TREATMENT OF OBSTRUCTIVE SLEEP APNEA WITH CONTINUOUS POSITIVE AIRWAY PRESSURE
B.A. Votteri, B.B. Shabatura, J.A. Reichert, W.A. Yates, E.F. Cundiff
Sequoia Hospital Sleep Disorders Center, Redwood City, California
Continuous Positive Airway Pressure (CPAP) is an accepted and highly effective method of treating Obstructive Sleep Apnea (OSA) and has been shown to be beneficial in the treatment of Central Sleep Apnea (CSA).1 The incidence of CSA following surgical treatment of OSA has been described by Guilleminault and Fletcher.2,3 The frequency of CSA following therapeutic nasal CPAP pressure in patients with OSA during one night studies was evaluated in 20 patients.
METHOD AND RESULTS
Twenty consecutive one night sleep studies of patients treated for OSA with nasal CPAP were selected. Standard PSG monitoring4 was utilized. Diaphragmatic EMG (DEMG) was includes to establish a definitive distinction between OSA and CSA.5 Respiratory events were scored in accordance to criteria of Guilleminault.4 Comparison was made of CSA frequency prior to and following therapeutic NCPAP pressure with observations categorized as follows:
#1 NO OSA PRIOR TO CPAP/NO CSA AFTER CPAP (43%)
#2 NO CSA PRIOR TO CPAP/CSA AFTER CPAP (50%)
#3 CSA PRIOR TO CPAP/NO CSA AFTER CPAP (7%)
#4 CSA PRIOR TO CPAP/CSA AFTER CPAP (0%)
Nine patients (43%) who showed no CSA prior to NCPAP, showed no CSA events after NCPAP titration. Ten patients (50%) who showed no CSA prior to NCPAP, showed CSA events after NCPAP titration. One patient (7%) who showed CSA prior to NCPAP, showed no CSA after NCPAP titration. No patients were observed having CSA both prior to and after NCPAP titration.
Central sleep apnea was frequently demonstrated following treatment of obstructive sleep apnea with continuous positive airway pressure. Our results are similar to the previously demonstrated frequency of central sleep apnea following the relief of obstructive sleep apnea by tracheostomy.2,5
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1 Issa F., Sullivann C., Chest 1986;90:165-171
2 Guilleminault C., Cummiskey J., Am. Rev. Respir. Dis. 1982;126:14-20
3 Fletcher E., Chest 1989;96(1):205-209
4 Guilleminault C., Sleeping and Waking Disorders. Menlo Park, CA: Addison-Wesley, 1982:196
5 Votteri, Pace, Reichert Yates. Sleep Research 1990;19:383