Positive airway pressure therapy in patients with opioid-related central sleep apnea.
OBJECTIVE
This study aims to compare treatment response and adherence rate to positive airway pressure (PAP) in patients with opioid-related central sleep apnea (O-CSA) and idiopathic central sleep apnea (I-CSA).


METHODS
We performed a retrospective chart over a 5-year period performed at a VA sleep center. Continuous PAP (CPAP) was prescribed initially for all participants. For those nonresponders (apnea hypopnea index (AHI) of >10/h), bi-level PAP (BiPAP) or adaptive servoventilation (ASV) was instituted upon provider's discretion. Adherence to therapy was checked with the built-in meter.


RESULTS
Thirty-four patients with O-CSA and 61 with I-CSA were included in the analysis. The two groups were comparable with respect to age, body mass index (BMI), Epworth Sleepiness Scale, and burden of comorbidities. The mean daily equivalent dose of morphine in the O-CSA was 168 mg (range 30-1,217 mg). In the O-CSA group, 24% of PAP-naïve patients responded to CPAP compared to 38% in the I-CSA group. BiPAP and ASV were comparable in eliminating central events in both O-CSA (66 versus 60 %) and I-CSA (93 versus 90%), respectively. Eight patients (24%) with O-CSA and six patients (10%) with I-CSA were considered nonresponders. The adherence rate was 48 and 24% in the I-CSA group compared to 23 and 18% in the O-CSA group at 3 and 12 months following initiation of effective treatment (p = 0.04 and p = 0.6).


CONCLUSIONS
The presence of O-CSA does not preclude an adequate response to CPAP. Adherence rate to PAP was poor in both the O-CSA and I-CSA groups. Further studies are needed to define optimal adherence rate and long-term benefits of PAP in CSA.
The Veterans Affairs Western New York Healthcare System, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Medical Research, Bldg. 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY, 14215-1199, USA.
Anthony
A
Troitino
Nawman
N
Labedi
Thomas
T
Kufel
Ali A
AA
El-Solh
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy*; D045422:Continuous Positive Airway Pressure; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010349:Patient Compliance; D017286:Polysomnography / Q000187:drug effects; D012189:Retrospective Studies; D020182:Sleep Apnea, Central / Q000139:chemically induced* / Q000628:therapy*; D012894:Sleep Stages / Q000187:drug effects
D000701:Analgesics, Opioid