Comparison of Therapeutic Approaches to Addicted Patients with Central Sleep Apnea

Nowadays, the most practical approaches used to treat sleep apnea, are Continuous Positive Airway Pressure (CPAP), Bi-level Positive Airway Pressure therapy (BPAP), supplemental O₂, servoventilation and/or a combination of these approaches simultaneously. However, each leads to different consequences in opioid related Central Sleep Apnea (CSA) patients. Given the high prevalence of CSA and frequently use of opioids worldwide, it seems that evaluation of the condition in these patients is required to determine their responsiveness to the above mentioned treatments and to choose the most appropriate therapy.

This longitudinal cross-sectional study included 41 opioid related CSA patients who underwent a step-by-step protocol (including CPAP, CPAP + O₂ and BPAP) in which if the patient was nonresponsive to a treatment, the next therapy was applied. If the patient was nonresponsive to all of these approaches, only oxygen was administered. Finally, the collected data were analyzed with SPSS software (ver. 22).

Among 41 participants, the responsiveness to CPAP, CPAP+O₂ and BPAP were 41.5%, 14.6% and 39%, respectively versus 4.9% nonresponsive patients to all above mentioned therapies. In patients with CSA and opium addiction, the CPAP and BPAP were the most effective treatments. In this group of patients, better response in the presence of higher Apnea-Hypopnea Index (AHI) was observed to BPAP, whereas better response in patients with lower AHI was to CPAP+O₂.

Accordingly, CPAP and BPAP are successful approaches to treat opioid related CSA patients in various medical conditions including long-run addiction course, concurrent smoking and addiction but it appears that further studies are essential.