Central Sleep Apnea Research Articles

Central Sleep Apnea due to Positive Airway Pressure Mask Leakage

Central Sleep Apnea due to Positive Airway Pressure Mask Leakage

The epidemiological characteristics of sleep disordered breathing in congestive heart failure: A prospective, single centre study in Southeast Asia.

The presence of sleep-disordered breathing (SDB) in congestive heart failure (CHF) is associated with poor prognosis and is underdiagnosed despite advances in CHF management. The prevalence of SDB in CHF remains understudied in South East Asia. A prospective, observational single-centre study was conducted where 116 consecutive patients in a specialised heart failure clinic underwent level 1, attended polysomnography (PSG). The prevalence of SDB was 78% using the apnoea-hypopnea index (AHI), AHI ⩾ 5/h threshold, and 59% with the AHI ⩾ 15/h threshold. Obstructive sleep apnoea (OSA) was the predominant type of SDB and was associated with increased body mass index and neck circumference. STOP-BANG was predictive of SDB, especially in men. Central sleep apnoea (CSA) patients had worse sleep indexes and lower awake arterial carbon dioxide. SDB was also homogenously present in preserved ejection fraction (EF) CHF. Most of the CHF patients were found to have SDB with the utility of PSG. Local CHF guidelines should include sleep testing for all patients with CHF.The study is registered on ClinicalTrials.gov (NCT05332223) as 'The Epidemiological Characteristics of SDB in Patients with Reduced or Preserved EF CHF'.

A bio-based, sweat-resistant and markedly sensitive iontronic skin for advancing central sleep apnea monitoring

Central Sleep Apnea (CSA) is characterized by respiratory pauses during sleep, posing risks like cardiovascular diseases, stroke and sudden death. The challenges in managing it arise from the current monitoring tools, which are often complicated and inaccurate. Furthermore, respiratory pauses leading to decreased blood oxygen can induce profuse sweating, further affecting accuracy. Herein, we have synthesized a bio-based, biocompatible and sweat-resistant polyurethane. By utilizing it as the matrix, we incorporated [BMIM]+[PF6]− to fabricate a markedly sensitive dielectric material, termed i-DFPU. The fluorine groups in i-DFPU contributed to a trap-release effect for migratable ions, while the alkyl side chains provided smooth ion migration channels, endowing i-DFPU with exceptional sensitivity. In combination with a stress concentration layer and serpentine-shaped electrodes, the resultant iontronic skin exhibited a remarkable sensitivity up to 132.2 kPa−1, operational stability and portability. Consequently, it could accurately monitor various respiratory states in CSA, potentially preventing complications such as sudden death.

Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study.

The objective of this study was to discern distinguishing characteristics of sleep-related breathing disorders in individuals with chronic spinal cord injury (CSCI) compared with participants without CSCI. Additionally, the study investigated factors associated with sleep-related breathing disorder severity. This is a cross-sectional analysis of 123 individuals without CSCI, 40 tetraplegics, and 48 paraplegics who underwent attended or partially supervised full polysomnography for suspected sleep-related breathing disorders in a rehabilitation center. Polysomnographic, transcutaneous capnography, and clinical data were collected and compared between the groups. Among tetraplegics, apnea-hypopnea index ≥ 30 events/h (67.5%, P = .003), central apnea (17.5%, P = .007), and higher oxygen desaturation index (80.0%, P = .01) prevailed. Sleep-related hypoventilation was present in 15.4% of tetraplegics and 15.8% of paraplegics, compared with 3.2% in participants without CSCI (P = .05). In the group without CSCI and the paraplegic group, snoring and neck circumference were positively correlated with obstructive sleep apnea (OSA) severity. A positive correlation between waist circumference and OSA severity was identified in all groups, and multivariate logistic regression analysis showed that loud snoring and waist circumference had the greatest impact on OSA severity. Severe OSA and central sleep apnea prevailed in tetraplegic participants. Sleep-related hypoventilation was more common in tetraplegics and paraplegics than in participants without CSCI. Loud snoring and waist circumference had an impact on OSA severity in all groups. We recommend the routine implementation of transcutaneous capnography in individuals with CSCI. We underscore the significance of conducting a comprehensive sleep assessment in the rehabilitation process for individuals with CSCI. Souza Bastos P, Amaral TLD, Yehia HC, Tavares A. Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study. J Clin Sleep Med. 2024;20(7):1119-1129.

Evaluation of a Pre-operative clinic's sleep apnea screening

BackgroundThis quality improvement (QI) project aimed to evaluate the process and outcomes of utilizing the STOP-BANG questionnaire (SBQ) to screen patients for sleep apnea in a pre-operative clinic. Studies outside the United States show that there is a greater risk for obstructive sleep apnea (OSA) among Asian ethnicity compared to Whites; thus, this project also aimed to describe the SBQ scores of a subset of Asian Americans not referred for a sleep study and determine the number of potential referrals if the body mass index (BMI) threshold in their SBQ scores is modified. MethodsA retrospective medical records review identified patients referred for a sleep study at the pre-operative clinic, described the sleep study outcome results, and identified gaps in the referral process that future QI projects can address. The records review also identified SBQ scores of Asian Americans not referred for a sleep study. Their scores were recalculated using a lower BMI threshold to determine the proportion of those who could have been referred. ResultsThere were 72,413 patient encounters at the pre-operative clinics from January 2019 to December 2021; 279 patients were referred for a sleep study. Only 103 (36.92 %) completed the test. There were 34 (33.01 %) confirmed to have severe sleep apnea, 28 (27.18 %) with moderate sleep apnea, 29 (28.16 %) with mild sleep apnea, and 12 (11.65 %) with no sleep apnea. Of the 176 (63.08 %) sleep study referrals not completed, the most common reasons for non-completion were issues with timely scheduling, educating patients to encourage study completion, and handling insurance denials. The mean BMI of the 1,560 Asian Americans not referred for a sleep study was 25.42 kg/m2, and only 2.31 % had a BMI > 35 kg/m2. Among the 162 Asian Americans with a history of sleep apnea, only 14.81 % had a BMI > 35 kg/m2. Adjusting the BMI threshold of SBQ increased the number of Asian Americans who could be referred for a sleep study by 1.35 % and 2.12 % if using a cut-off of > 30 kg/m2 and > 28 kg/m2, respectively. ConclusionsScreening of OSA using the SBQ in a pre-operative clinic effectively identified patients at high risk for sleep apnea. The low completion rate of sleep study referrals shows a gap in the referral process that requires improvement. Asian Americans with sleep apnea have lower BMIs. Attention to BMI thresholds would increase the identification of sleep apnea in this vulnerable population.

Type one chiari malformation as a cause of central sleep apnea and hypoventilation in children

ObjectivesChiari type 1 malformation (CM1) may occasionally lead to central sleep apnea (CSA). We studied, in a large clinical cohort of pediatric CM1 patients, the effect of CM1 on breathing during sleep. MethodsThis is a retrospective single pediatric pulmonology center study with a systematic evaluation of pediatric CM1 patients under age 18 with polysomnography (PSG) during 2008–2020. Children with syndromes were excluded. All patients had undergone head and spine magnetic resonance imaging. ResultsWe included 104 children with CM1 with a median age of 7 (interquartile range (IQR) 5–13) years. The median extent of tonsillar descent (TD) was 13 (IQR 10–18) mm. Syringomyelia was present in 19 children (18%). Of all children, 53 (51%) had normal PSG, 35 (34%) showed periodic breathing or central apnea and hypopnea index ≥5 h−1, and 16 (15%) displayed features of compensated central hypoventilation and end-tidal or transcutaneous carbon dioxide 99th percentile level above 50 mmHg. TD had the best predictive value for central breathing disorders. In a linear model, both age (61%) and TD (39%) predicted median breathing frequency (R = 0.33, p < 0.001). ConclusionsAlthough severe CSA is a rare complication of brainstem compression in pediatric patients with CM1, short arousal-triggered episodes of periodic breathing and mild compensated central hypoventilation are common. TD shows the best but still poor prediction of the presence of a central breathing disorder. This highlights the use of PSG in patient evaluation. Posterior fossa decompression surgery effectively treats central breathing disorders.

Medication-induced central sleep apnea: a unifying concept.

Medication-induced central sleep apnea (CSA) is one of the eight categories of causes of CSA but in the absence of awareness and careful history may be misclassified as primary CSA. While opioids are a well-known cause of respiratory depression and CSA, non-opioid medications including sodium oxybate, baclofen, valproic acid, gabapentin, and ticagrelor are less well-recognized. Opioids-induced respiratory depression and CSA are mediated primarily by µ-opioid receptors, which are abundant in the pontomedullary centers involved in breathing. The non-opioid medications, sodium oxybate, baclofen, valproic acid, and gabapentin, act upon brainstem gamma-aminobutyric acid (GABA) receptors, which co-colonize with µ-opioid receptors and mediate CSA. The pattern of ataxic breathing associated with these medications is like that induced by opioids on polysomnogram. Finally, ticagrelor also causes periodic breathing and CSA by increasing central chemosensitivity and ventilatory response to carbon dioxide. Given the potential consequences of CSA and the association between some of these medications with mortality, it is critical to recognize these adverse drug reactions, particularly because discontinuation of the offending agents has been shown to eliminate CSA.

Occurrence of Arterial Hypertension in Patients with sleep Apnoea Syndrome

Introduction: Sleep apnoea syndrome (SAS) is a serious under-diagnosed chronic disease, which often coincides with arterial hypertension (AH). The U.S. Joint National Committee considers SAS to be the most common cause of secondary arterial hypertension. Objective: To determine the incidence of arterial hypertension in patients diagnosed with SAS in an accredited sleep laboratory (ASL) in Bratislava in the years 2013-2022. Methods: The monitored group consisted of 688 patients examined in an ASL in Bratislava who underwent an initial examination (anamnesis, anthropometry, sleep questionnaire) and a diagnosis of sleep-disordered breathing (nocturnal polysomnography) in order to confirm or refute the diagnosis of OSAS. Data collection also took place by using a copy of the patients’ medical records (presence of AH). We used Microsoft Excel and statistical software SPSS, version 21.0 to process the obtained data. We considered the result to be statistically significant if p ≤ 0.05. Results: We demonstrated a statistically significant difference in the incidence of AH in patients with SAS compared to patients without SAS, i.e., there was a statistically significantly higher incidence of AH in patients with SAS compared to patients without SAS (39% vs. 17.5%; OR=3.0; p&lt;0.001). We also demonstrated that the higher the AHI value in patients with SAS, the higher the incidence of AH (p=0.002; 95% CI 1.4 – 4.4). In addition, there was a 1.9 times higher risk of developing AH in patients with a moderate degree of SAS compared to patients with a mild degree of SAS (p=0.014) and up to a 2.8 times higher risk of developing AH in patients with a severe degree of SAS compared to patients with moderate SAS (p&lt;0.001) regardless of BMI. Conclusion: Due to the high coincidence (1/3) of arterial hypertension and sleep apnoea syndrome in the monitored group, it is necessary to focus on effective screening of SAS in high-risk persons as well as effective screening of SAS in persons with present AH.

The prevalence and polysomnographic characteristics of treatment-emergent central sleep apnea with obstructive sleep apnea.

To investigate the prevalence of treatment-emergent central sleep apnea (TECSA) in individuals with obstructive sleep apnea syndrome (OSAS) during continuous positive airway pressure (CPAP) titration and assess their polysomnographic characteristics. A total of 116 patients with OSAS who underwent full-night CPAP titration at the Sleep Laboratory of Adana City Research and Education Hospital from September 2017 to January 2018 were recruited for the study. The patients' polysomnographic data related to respiratory events and sleep stages were reviewed in a retrospective manner. While on CPAP titration, 20 of the 116 patients developed central sleep apnea (CSA). The prevalence of TECSA in the patients with OSAS was 17.2%, being separately determined as 16.3% and 2.2% for the male and female patients, respectively. In the baseline PSG, the groups did not statistically significantly differ in relation to the apnea hypopnea index (AHI), central apnea index (CAI), arousal index (AI), or oxygen desaturation index (ODI). However, the TECSA group had a significantly higher mean oxygen saturation value compared to the non-TECSA group (p = 0.01). The total AHI, CAI, and AI values of the TECSA group were significantly higher during the whole CPAP titration compared to the non-TECSA group. No significant difference was observed in the comparison of the two groups in relation to the titration pressure and ODI. TECSA is a phenomenon that can occur with obstructive sleep apnea treatment and mostly regress spontaneously following appropriate CPAP treatment. TECSA is observed at different rates of prevalence. In this study, the prevalence of TECSA was higher than previously reported.

Effects of Tonsillectomy and Adenoidectomy on Central Sleep Apnea in children with adenoid and tonsillar hypertrophy and exploration of influential factors

Effects of Tonsillectomy and Adenoidectomy on Central Sleep Apnea in children with adenoid and tonsillar hypertrophy and exploration of influential factors

Sleep Apnea is Not an Obstacle for Outpatient Hip and Knee Arthroplasty

BackgroundUp to 25% of patients requiring hip or knee arthroplasty have sleep apnea (SA), and these patients have historically been excluded from outpatient programs. The objectives of this study were to evaluate same-day discharge failure as well as 30-day complications, readmissions, and unexpected visits. MethodsA retrospective case-control study comparing patients who have and do not have SA matched for age, sex and arthroplasty type (total hip arthroplasty, total knee arthroplasty, unicompartimental knee arthroplasty) who underwent primary outpatient surgery between February 2019 and December 2022 in 2 academic hospitals was conducted. Cases with mild SA, moderate SA with a body mass index (BMI) <35, and SA of all severity treated by continuous positive airway pressure machines were eligible. There were 156 patients included (78 cases). Complications were assessed according to the Clavien-Dindo Classification and the Comprehensive Complication Index. Continuous variables were evaluated by Student's T or Mann-Whitney tests, while categorical data were analyzed by Chi-square or Fisher tests. Univariate analyses were performed to determine discharge failure risk factors. ResultsThere were 6 cases (7.7%) and 5 controls (6.4%) who failed to be discharged on surgery day (P = .754), with postoperative hypoxemia (6, [3.8%]) and apnea periods (3, [1.9%]) being the most common causes. Higher BMI (odds ratio = 1.19, P = .013) and general anesthesia (odds ratio = 11.97, P = .004) were found to be risk factors for discharge failure. No difference was observed on 30-day readmissions (P = .497), unexpected visits (P = 1.000), and complications on the Clavien-Dindo Classification (P > .269) and Comprehensive Complication Index (P > .334) scales. ConclusionsSelected patients who have SA can safely undergo outpatient hip or knee arthroplasty. Higher BMI and general anesthesia increased the odds of same-day discharge failure. Level of EvidenceLevel III, Case-control Study.

Hippocampal neurons change spike rates before the episodes of central sleep apnea

Hippocampal neurons change spike rates before the episodes of central sleep apnea

Phrenic nerve stimulation for the treatment of central sleep apnea in patients with heart failure

Phrenic nerve stimulation for the treatment of central sleep apnea in patients with heart failure

The influence of ethnic background on altitude-induced central sleep apnea

The influence of ethnic background on altitude-induced central sleep apnea

Resolution of central sleep apnea after percutaneous coronary intervention (PCI) with DES implantation- a case study

Resolution of central sleep apnea after percutaneous coronary intervention (PCI) with DES implantation- a case study

Central sleep apnea treated by a constant low dose CO2 supplied by a novel device

Central sleep apnea treated by a constant low dose CO2 supplied by a novel device

Sleep disordered breathing assessment in patient with slowly progressive neuromuscular disease

BackgroundSleep-disordered breathing (SDB) is common in patients with neuromuscular diseases (NMD). Focusing on hypercapnia may lead to the neglect of other SDB such as obstructive and/or central sleep apnea syndrome (SAS). Our objectives were to assess the risk of inappropriate SDB management according to different screening strategies and to evaluate the prevalence and determinants of isolated and overlapping sleep apnea in patients with slowly progressive NMD. MethodsThis monocentric, cross-sectional, retrospective study analyzed medical records of adult NMD patients referred to a sleep department. Diagnostic strategies, including respiratory polygraphy (RP), nocturnal transcutaneous capnography (tcCO2), and blood gases (BG), were assessed for their performance in diagnosing SDB. Demographics and pulmonary function test results were compared between patients with or without SDB to identify predictors. ResultsAmong the 149 patients who underwent a full diagnostic panel (RP + tcCO2 + BG), 109 were diagnosed with SDB. Of these, 33% had isolated SAS, and central apneas were predominant. Using single diagnostic strategies would lead to inappropriate SDB management in two thirds of patients. A combination of 2 diagnostic tools resulted respectively in 21.1, 22.9 and 42.2 % of inappropriate SDB management for RP + tcCO2, RP + BG and tcCO2 + BG. ConclusionThe significant prevalence of sleep apnea syndrome in patients with slowly progressive NMD highlights the need for increased awareness among clinicians. Improved diagnostics involve a systematic approach addressing both sleep apnea and diurnal and nocturnal alveolar hypoventilation to avoid inappropriate management and limit the consequences of SDB.

Perry Disease: Bench to Bedside Circulation and a Team Approach.

With technological applications, especially in genetic testing, new diseases have been discovered and new disease concepts have been proposed in recent years; however, the pathogenesis and treatment of these rare diseases are not as well established as those of common diseases. To demonstrate the importance of rare disease research, in this paper we focus on our research topic, Perry disease (Perry syndrome). Perry disease is a rare autosomal dominant neurodegenerative disorder clinically characterized by parkinsonism, depression/apathy, weight loss, and respiratory symptoms including central hypoventilation and central sleep apnea. The pathological classification of Perry disease falls under TAR DNA-binding protein 43 (TDP-43) proteinopathies. Patients with Perry disease exhibit DCTN1 mutations, which is the causative gene for the disease; they also show relatively uniform pathological and clinical features. This review summarizes recent findings regarding Perry disease from both basic and clinical perspectives. In addition, we describe technological innovations and outline future challenges and treatment prospects. We discuss the expansion of research from rare diseases to common diseases and the importance of collaboration between clinicians and researchers. Here, we highlight the importance of researching rare diseases as it contributes to a deeper understanding of more common diseases, thereby opening up new avenues for scientific exploration.

Prevalence of central sleep apnea among veterans and response rate to continuous positive airway pressure therapy.

Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans. Veterans were screened from a single VA medical center who had polysomnography (PSG) study from 2017 to 2021 to ascertain the presence, severity, and type of SDB by measuring the apnea-hypopnea index (AHI) and central apnea index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/hour. Diagnostic "CSA only" was defined as AHI ≥ 10 events/hour and CAI ≥ 50% of AHI. "OSA only" was defined if AHI ≥ 10 events/hour and CAI < 5 events/hour. Comorbid central and obstructive sleep apnea (COSA) was defined if AHI ≥ 10 events/hour and CAI > 5 events/hour but < 50% of AHI. The responsiveness to PAP therapy was determined based on the CAI < 5 events/hour on the titration study. A total of 90 patients met the inclusion criteria and from those 64 Veterans were found to have COSA (71%), 18 (20%) were CSA only, and 8 (9%) were OSA only. A total of 22 (24.4%) Veterans diagnosed with CSA or COSA were responsive to PAP therapy. Sixty days after treatment initiation, both responsive and nonresponsive groups had significant decreases in AHI and CAI (p < 0.05). Comorbid central and obstructive SDB is common among Veterans. The response to PAP therapy is suboptimal but improves over time.

Clinical and PSG Characteristics Comparison of Central Sleep Apnea in the Elderly and Non-Elderly Patients.

To explore the characteristics of elderly patients with central sleep apnea (CSA). This retrospective study divided 123 patients with CSA into elderly and non-elderly groups, and compared them in terms of demographic characteristics (age, BMI, etc), underlying diseases (hypertension, coronary heart disease, and cardiac arrhythmias, etc). and polysomnography parameters. Multiple linear regression analysis was conducted to investigate the potential risk factors of central apnea index (CAI). Compared with the non-elderly group, patients in the elderly group had lower body mass index, a higher proportion of comorbidities of coronary heart disease, arrhythmias, and diabetes, lower apnea-hypopnea index (AHI), obstructive apnea index (OAI) and oxygen desaturation index (ODI). CAI of the elderly group showed a trend higher than that of the non-elderly group with no statistical difference. However, the ratio of CAI to AHI in the elderly group was significantly higher (0.264 vs 0.154, P=0.003). True CSA was less prevalent than companion CSA in both groups. The results of multiple regression analysis indicated CAI was independently associated with age (β=0.256, P=0.005), OAI (β=-0.543, P<0.001), MAI (β=-0.267, P=0.005), ODI (β=0.538, P<0.001), heart failure (β=0.300, P<0.001). CSA typically coexists with other types of sleep apnea. Elderly CSA patients have characteristics such as a lower BMI, and a milder decrease in blood oxygen saturation, along with higher prevalence of arrhythmia and coronary heart disease. Age may be a potential risk factor for CSA.