SESSION TITLE: Sleep Disorders II
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 02:45 PM - 04:15 PM
PURPOSE: To compare treatment response to positive airway pressure in patients with narcotic induced central sleep apnea (N-CSA) and idiopathic central sleep apnea (I-CSA).
METHODS: We performed a non-concurrent prospective study at VA Western New York Health care system during the period of January 2006 to December 2012. Patients diagnosed with CSA by polysomnography were classified into opioid related CSA (n=34) and idiopathic CSA (n=61). CPAP was prescribed initially for all participants. For those non-responders (AHI>10/h), BIPAP or ASV was instituted upon provider’s discretion. Participants were followed up at least once per year for a mean of 3.1 years (SD 2.2). Adherence to therapy (>4/h per night) was checked with the built-in meter.
RESULTS: 34 patients with N-CSA and 61 with I-CSA were included in the analysis. The two groups were comparable with respect to age, BMI, Epworth Sleepiness scale and burden of comorbidities. The mean equivalent dose of morphine in the N-CSA was 68 mg (range 30-217 mg). In the N-CSA group, 24% of patients responded to CPAP, 18% to BiPAP and 35% to ASV. In comparison, 38% of I-CSA responded to CPAP, 11% to BiPAP and 20% to ASV. Eight patients (24%) with N-CSA and 6 patients (10%) with I-CSA were considered non-responders. Thirteen refused treatment. The adherence rate was 48% and 34% in the I-CSA group compared to 23% and 18% in the N-CSA group at 3- and 12-month following initiation of effective treatment (p = 0.04 and p=0.13).
CONCLUSIONS: The presence of N-CSA does not preclude adequate response to CPAP. There was no significant difference between the two groups in the effectiveness of BIPAP or ASV with overall success rate of 83%. Adherence to treatment is poor.
CLINICAL IMPLICATIONS: Patients with central sleep apnea should receive initial CPAP titration. Further studies are needed to identify factors associated with effective response to ASV or BIPAP.
DISCLOSURE: The following authors have nothing to disclose: Roopika Reddy, Anthony Troitino, Ali El-Solh
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