Treatment of central sleep apnea in U.S. veterans.
BACKGROUND
There are no standard therapies for the management of central sleep apnea (CSA). Either positive pressure therapy (PAP) or supplemental oxygen (O(2)) may stabilize respiration in CSA by reducing ventilatory chemoresponsiveness. Additionally, increasing opioid use and the presence of comorbid conditions in US veterans necessitates investigations into alternative titration protocols to treat CSA. The goal was to report on the effectiveness of titration with PAP, used alone or in conjunction with O(2), for the management of CSA associated with varying comorbidities and opioid use.


METHODS
This was a retrospective chart review over 3 years, performed at a VA sleep disorders center. The effects of CPAP, CPAP+O(2), and BPAP+O(2), used in a step-wise titration protocol, on consecutive patients diagnosed with CSA were studied.


RESULTS
CSA was diagnosed in 162 patients. The protocol was effective in eliminating CSA (CAI ≤ 5/h) in 84% of patients. CPAP was effective in 48%, while CPAP+O(2) combination was effective in an additional 25%, and BPAP+O(2) in 11%. The remaining 16% were non-responders. Forty-seven patients (29%) were on prescribed opioid therapy for chronic pain, in whom CPAP, CPAP+O(2), or BPAP+O(2) eliminated CSA in 54%, 28%, and 10% cases, respectively. CPAP, CPAP+O(2), and BPAP+O(2) each produced significant declines in the AHI, CAI, and arousal index, and an increase in the SpO(2).


CONCLUSIONS
The data demonstrate that using a titration protocol with CPAP and then PAP with O(2) effectively eliminates CSA in individuals with underlying comorbid conditions and prescription opioid use. Comparative studies with other therapeutic modalities are required.
Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, USA. schowdh@med.wayne.edu
Susmita
S
Chowdhuri
Ahmed
A
Ghabsha
Prabhat
P
Sinha
Medina
M
Kadri
Simranjit
S
Narula
M Safwan
MS
Badr
D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D017286:Polysomnography; D012189:Retrospective Studies; D020182:Sleep Apnea, Central / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
D000701:Analgesics, Opioid