Comparative Evaluation of Therapeutic Approaches to Central Sleep Apnea

To date, there is no standard approach to manage and to improve central sleep apnea (CSA). The most applicable therapeutic approaches are positive airway pressure therapy (PAP), bi-level PAP therapy (BIPAP), supplemental O₂ and servo ventilation, or a combination of two approaches. Given the high prevalence of heart disease (HF) and/or concomitants of other diseases and opioid use worldwide; it seemingly requires evaluation of patients' conditions in response to each abovementioned approach to select the most effective approach.

This longitudinal cross-sectional study included 64 CSA patients who had undergone continuous PAP (CPAP), CPAP + O₂, and BiPAP. Hence, if a patient was nonresponsive to a treatment, the next was applied. If the patient was nonresponsive to all approaches, oxygen alone was administered. The collected data were analyzed with SPSS.

The study of 64 CSA patients showed that frequencies of response to CPAP, CPAP + O₂, and BiPAP were 42.2%, 20.3%, and 28.1%, respectively. While 9.4% of patients with histories of congestive heart failure (CHF) and ischemic heart disease (IHD) who were older than others and with the highest apnea-hypopnea index, were nonresponsive to all approaches. CPAP therapy showed more appropriate results in patients with CHF and IHD. Furthermore, patients with the history of opioid use showed the most positive results in response to CPAP and BIPAP.

The results suggest that CPAP and BIPAP are, respectively, the most effective therapeutic approaches to CSA in patients with the histories of HF and opioid use, but CPAP + O₂ could be reliable in some conditions as well. Therefore, it may require further studies to be clarified.