Treatment-emergent central sleep apnea (Te-Csa)

Öz

Treatment-emergent central sleep apnea (TE-CSA) is a condition in which central sleep apnea (CSA) occurs in patients treated with obstructive sleep apnea (OSA) in a diagnostic part of the sleep test, while the obstructive apnea is controlled during the treatment process. TE-CSA is seen in approximately 5-10% of OSA patients. The prevalence of TE-CSA is higher in patients with cardiac comorbidities such as heart failure. In patients with TE-CSA, the use of positive airway pressure (PAP) therapy and treatment compliance were found to be poor compared to patients with classical OSA, unless appropriate therapy was chosen. Recognition and assessment of the TE-CSA course and initiation of targeted management for TE-CSA may improve symptom control and quality of life in patients with sleep-disordered breathing.

Anahtar Kelimeler

• TE-CSA
• BPAP
• ASV

Tedaviyle ortaya çıkan santral uyku apnesi (Te-Csa)

Öz

Tedaviyle ortaya çıkan santral uyku apnesi (TE-CSA), obstrüktif uyku apne (OSA) tanısı ile tedavi başlanan hastalarda, tedavi sürecinde obstrüktif apneler kontrol altına alınmasına rağmen, santral uyku apnesinin (CSA) ortaya çıkmasıdır. OSA hastalarının yaklaşık %2-20’sinde TE-CSA görülmekte olup TE-CSA prevalansı kardiyak komorbiditeleri olan hastalarda daha yüksektir. TE-CSA hastalarında, uygun tedavi seçilmediği takdirde, klasik OSA'lı hastalara kıyasla pozitif havayolu basınç (PAP) tedavisi kullanımının ve tedavi uyumunun zayıf olduğu saptanmıştır. TE-CSA tanılı hastaların değerlendirilmesi ve uygun tedavilerin başlanması, uykuda solunum bozukluğu olan hastalarda, semptom kontrolünü ve yaşam kalitesini iyileştirebilir.

Anahtar Kelimeler

• TE-CSA
• BPAP
• ASV

Kaynakça

1. Allam, J.S., Olson, E.J., Gay, P.C. & Morgenthaler, T.I. (2007). Efficacy of adaptive servo ventilation in treatment of complex and central sleep apnea syndromes. Chest., 132, 1839–46.
2. American Academy of Sleep Medicine. (2014).
3. Andreas, S., Weidel, K., Hagenah, G. & Heindl, S. (1998). Treatment of Cheyne-Stokes respiration with nasal oxygen and carbon dioxide. Eur Respir J., 12, 414–9.
4. Cassel, W., Canisius, S., Becker, H.F., Leistner, S., Ploch, T., Jerrentrup, A., Vogelmeier, C., … & Heitmann, J. (2011). A prospective polysomnographic study on the evolution of complex sleep apnoea. Eur Respir J., 38, 329–37.
5. Cowie, M.R., Woehrle, H., Wegscheider, K., Angermann, C., d’Ortho, M., Erdmann, E., Levy, P., … & Teschler, H. (2015). Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med., 373, 1095–105.
6. Eckert D.J., Owens R.L., Kehlmann G.B., Wellman, A., Rahangdale, S., Yim-Yeh, S., White D.P., …& Malhotra, A. (2011). Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with alow arousal threshold. Clin Sci., 120, 505–14.
7. Edwards, B.A., Sands, S.A., Eckert, D.J., White, D.P., Butler, J.P., Owens, R.L., Malhotra & Wellman, A.A. (2012). Acetazolamide improves loop gain but not the other physiological traits causing obstructive sleep apnoea. J Physiol., 590, 1199–211.
8. Eskandari, D., Zou, D., Grote, L., Hoff, E. & Hedner, J. (2018). Acetazolamide reduces blood pressure and sleep-disordered breathing in patients with hypertension and obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med., 14, 309–17.

9. Heider, K., Arzt, M., Lerzer, C., Kolb, L., Pfeifer, M., Maier, L.S., Gfüllner, F. & Malfertheiner, M.V. (2018). et al. Adaptive servo-ventilation and sleep quality in treatment emergent central sleep apnea and central sleep apnea in patients with heart disease and preserved ejection fraction. Clin Res Cardiol., 107, 421–9.
10. Javaheri, S., Smith, J. & Chung, E. (2009). The prevalence and natural history of complex sleep apnea. J Clin Sleep Med., 5, 205–11.
11. Khayat, R.N., Xie, A., Patel, A.K., Kaminski, A. & Skatrud, J.B. (2003). Cardiorespiratory effects of added dead space in patients with heart failure and central sleep apnea. Chest., 123, 1551–60.
12. Kuzniar, T.J. & Morgenthaler, T.I. (2012). Treatment of complex sleep apnea syndrome. Chest, 142, 1049–57.
13. Kuzniar, T.J., Kasibowska-Kuzniar, K., Ray, D.W. & Freedom,T. (2013). Clinical heterogeneity of patients with complex sleep apnea syndrome. Sleep Breath, 17, 1209–14.
14. Lettieri, C.J., Quast, T.N., Eliasson, A.H. & Andrada, T. (2008). Eszopiclone improves overnight polysomnography and continuous positive airway pressure titration: a prospective, randomized, placebo-controlled trial. Sleep, 31, 1310–6.
15. Liu, D., Armitstead, J., Benjafield, A., Shao, S.,Malhotra, A., Cistulli, P.A., Pepin, J.L. & Woehrle, H. (2017). Trajectories of emergent central sleep apnea during CPAP therapy. Chest, 152, 751–60.
16. Montesi, S.B., Bakker, J.P., Macdonald, M., Hueser, L., Pittman, S., White D.P. & Malhotra, A. (2013). Air leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med., 9, 1187–91.
17. Morgenthaler, T.I., Kuzniar, T.J., Wolfe, L.F., Willes, L., McLain, WC 3rd, & Goldberg, R. (2014). The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servo ventilation therapy. Sleep, 37, 927–34.
18. Moro, M., Gannon, K., Lovell, K., Merlino, M., Mojica, J. & Bianchi, M.T. (2016). Clinical predictors of central sleep apnea evoked by positive airway pressure titration. Nat Sci Sleep, 8, 259–66.
19. Nigam, G., Pathak, C. & Riaz, M. (2016). A systematic review on prevalence and risk factors associated with treatment- emergent central sleep apnea. Ann Thorac Med., 11, 202–10.
20. Nigam, G., Riaz, M., Chang, E.T. & Camacho, M. (2018). Natural history of treatment-emergent central sleep apnea on positive airway pressure: a systematic review. Ann Thorac Med., 13, 86–91.
21. Park, J.G., Olson, E.J. & Morgenthaler, T.I. (2013). Impact of zaleplon on continuous positive airway pressure therapy compliance. J Clin Sleep Med., 9, 439–44.
22. Quadri, S., Drake, C. & Hudgel, D.W. (2009). Improvement of idiopathic central sleep apnea with zolpidem. J Clin Sleep Med., 5, 122–9.
23. Xie, A., Teodorescu, M., Pegelow, D.F., Teodorescu, M.C., Gong, Y., Fedie, J.E. & Dempjey J.A. (2013). Effects of stabilizing or increasing respiratory motor outputs on obstructive sleep apnea. J Appl Physiol., 115, 22–33.