31
AASM Membership Sections Newsletter
■
Issue #6
Day
AHI
OAI
CAI
2
12.0
2.0
8.0
4
5.7
1.1
3.1
6
6.3
0.7
3.8
8
4.1
0.4
2.4
10
4.5
0.4
2.6
12
5.2
1.0
2.3
had resolution of TE-CSA. The two patients that had persistent
CSA beyond this time period underwent ABG and TTE, and these
patients were noted to have diastolic dysfunction as well as lower
arterial carbon dioxide levels in the morning. Although there is
limited data, TE-CSA generally seems to resolve over the course
of weeks. Those patients that have persistent CSA may have an
underlying predisposition to CSA.
Clinical Course of Our Patient: He was started on CPAP of 7 cm
H2O and a wireless modem was attached to his CPAP machine.
Over the course of the next two weeks, his TE-CSA was nearly
resolved as depicted in Figure 3 below. His sleepiness also was noted
to be resolved on a subsequent visit.
4.
How is TE-CSA treated?
As discussed above, TE-CSA may resolve overtime with use of
CPAP. However, there are individuals as described by Dernaika
and group that may have persistent CSA even after several weeks.
Treatment for this group of patients as well as other CSA is
accomplished with adaptive servo-ventilation (ASV). The ASV
device appears to be an effective treatment for CSA syndromes that
are resistant to CPAP.
References:
1. Allam JS, Olson EJ, Gay PC, Morgenthaler TI. Efficacy of
adaptive servoventilation in treatment of complex and central
sleep apnea syndromes. Chest 2007; 132(6): 1839-46.
2. Dempsey JA. Crossing the apnoeic threshold: causes and
consequences. Experimental Physiology 2005; 90:13
3. Dernaika T, Tawk M, Nazir S, Younis W, Kinasewitz GT. The
significance and outcome of continuous positive airway pressure-
related central sleep apnea during split-night studies. Chest 2007;
132(1): 81-87.
4. Hoffman M and Schulman DA. The appearance of central sleep
apnea after treatment of obstructive sleep apnea. Chest 2012;
142(2): 517-22.
Figure 3a:
Graph above depicts AHI (apnea-
hypopnea index), OAI (obstructive apnea index) and
CAI (central apnea index) as reported by his CPAP
machine and transmitted via his wireless modem over
12 weeks.
Figure 3b:
Figure Chart listing the patient AHI, OAI
and CAI over the course of 12 weeks.
