Nocturnal hypoxemic burden during positive airway pressure treatment across different central sleep apnea etiologies

Dominik Linz, Maximilian Valentin Malfertheiner, Nils Werner, Christoph Lerzer, Florian Gfüllner, Benedikt Linz, Florian Zeman, R Doug McEvoy, Michael Arzt, Mathias Baumert
Sleep Medicine 2021 January 5, 79: 62-70

INTRODUCTION: Nocturnal hypoxemia is associated with increased cardiovascular mortality. Here, we assess whether positive airway pressure by adaptive servo-ventilation (ASV) reduces nocturnal hypoxemic burden in patients with primary central sleep apnea (primary CSA), or heart failure related central sleep apnea (CSA-HF) and treatment emergent central sleep apnea (TECSA).

METHODS: Overnight oximetry data from 328 consecutive patients who underwent ASV initiation between March 2010 and May 2018 were retrospectively analyzed. Patients were stratified into three groups: primary CSA (n = 14), CSA-HF (n = 31), TECSA (n = 129). Apnea hypopnea index (AHI) and time spent below 90% SpO2 (T90) was measured. Additionally, T90 due to acute episodic desaturations (T90Desaturation ) and due to non-specific and non-cyclic drifts of SpO2 (T90Non-specific ) were assessed.

RESULTS: ASV reduced the AHI below 15/h in all groups. ASV treatment significantly shortened T90 in all three etiologies to a similar extent. T90Desaturation , but not T90Non-specific , was reduced by ASV across all three patient groups. AHI was identified as an independent modulator for ΔT90Desaturation upon ASV treatment (B (95% CI: -1.32 (-1.73; -0.91), p < 0.001), but not for ΔT90 or ΔT90Non-specific . Body mass index was one independent predictor of T90.

CONCLUSIONS: Across different central sleep apnea etiologies, ASV reduced AHI, but nocturnal hypoxemic burden remained high due to a non-specific component of T90 not related to episodic desaturation. Whether adjunct risk factor management such as weight-loss can further reduce T90 warrants further study.

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