0976 Central Sleep Apnea (CSA) following treatment with Non-Positive Airway Pressure (PAP) Modalities

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Abstract Introduction Emergence or worsening of CSA following non- PAP therapies has not been well studied. We present two cases of CSA following treatment of OSA; one with mandibular advancing device (MAD) and other with hypoglossal nerve stimulation (HGNS). Report of case(s) Case 1: A78 y/o male presented with CPAP intolerance and seeking HGNS for OSA treatment. His AHI was 25 with an O2 nadir of 76%. Following a comprehensive evaluation including sleep endoscopy, he was deemed a good candidate for HGNS. Per protocol, his HGNS was activated, PSG done after an interval period during which his stimulation was titrated from 0-2.3V. His AHI remained elevated (50 – 163) at all voltage settings with emergence of CSA at 2.3 & 2.4 V. Due to tongue discomfort, his stimulation parameters were changed and HSAT was done to re-assess his breathing. Home study showed persistent severe sleep apnea- central & obstructive with periodic breathing and desaturations to 70s. Case 2: A 28-y/o male with OSA AHI of 20.2 and O2 nadir of 82%. He was intolerant of CPAP; hence MAD was pursued. PSG done showed MAD was ineffective as his AHI was elevated at 26.8 with elevated CAI (associated with desaturations). A repeat study at home was done following adjustments to the MAD showed a higher index with pAHI of 37.7, predominantly central in nature with periodic breathing. Patient is awaiting a CPAP titration but has returned back to PAP therapy with good tolerance and resolution of his residual symptoms including daytime hypersomnolence. Conclusion These two cases highlight that CSA can be associated with non-PAP therapies and symptomatic improvement alone may not be an effective approach. Testing following initiation of treatment would allow for more effective management especially when patient is symptomatic or treatment is suspected to be ineffective. Support (if any)