Treatment-emergent central sleep apnea resolves with lower inspiratory pressure

Treatment-emergent central sleep apnea (TECSA) is an important problem during therapy with continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea. We tested a device designed to improve CPAP comfort through reducing inspiratory positive airway pressure (IPAP; $\dot{\text{V}}\text{-Com}$) to determine whether such a reduction in IPAP could eliminate central apneas in patients with TECSA. Because increasing tidal volume (potentially via IPAP increments) has been suggested as a possible mechanism contributing to TECSA onset, our hypothesis was that reducing IPAP would yield a drop in the central apnea index.

The addition of a known resistance ($\dot{\text{V}}\text{-Com}$ device) that reduces IPAP was implemented into the CPAP circuit during the second half of CPAP titrations in a cohort of community-dwelling patients who developed TECSA during a split-night CPAP titration. Central apnea index was quantified from the sleep periods without and with $\dot{\text{V}}\text{-Com}$ in place.

A total of 1,613 patients underwent CPAP titration, with 19 of them developing TECSA during the titration. The addition of $\dot{\text{V}}\text{-Com}$ resulted in complete resolution of TECSA in all patients with adequate sleep data under all conditions (n = 13), yielding a significant reduction in the central apnea index (17.3 ± 11.0 vs 1.5 ± 1.7 events/h without and with $\dot{\text{V}}\text{-Com}$, respectively; P < .001).

$\dot{\text{V}}\text{-Com}$ virtually resolved all instances of TECSA, suggesting that reducing IPAP could be an effective strategy for managing the occurrence of central respiratory events in patients with obstructive sleep apnea using CPAP.

Noah WH, Messineo L, Hete B, et al. Treatment-emergent central sleep apnea resolves with lower inspiratory pressure. J Clin Sleep Med. 2025;21(3):559-564.