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

doi:10.1016/j.sleep.2021.01.007

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

Sleep Med. 2021 Mar:79:62-70. doi: 10.1016/j.sleep.2021.01.007. Epub 2021 Jan 5.

Affiliations

¹ Center for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands. Electronic address: dominik.linz@mumc.nl.
² Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
³ Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany.
⁴ University of Copenhagen, Faculty of Health Science, Department of Biomedical Sciences, Copenhagen, Denmark.
⁵ Centre for Clinical Studies, University Medical Centre, Regensburg, Germany.
⁶ Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia.
⁷ University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia.

PMID: 33482454
DOI: 10.1016/j.sleep.2021.01.007

Abstract

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 (T90_Desaturation) and due to non-specific and non-cyclic drifts of SpO₂ (T90_Non-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. T90_Desaturation, but not T90_Non-specific, was reduced by ASV across all three patient groups. AHI was identified as an independent modulator for ΔT90_Desaturation upon ASV treatment (B (95% CI: -1.32 (-1.73; -0.91), p < 0.001), but not for ΔT90 or ΔT90_Non-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.

Keywords: Adaptive servo-ventilation; Continuous positive airway pressure; Heart failure; Oximetry; Sleep apnea; Sleep-disordered breathing.

MeSH terms

Continuous Positive Airway Pressure
Heart Failure*
Humans
Respiration
Retrospective Studies
Sleep Apnea, Central* / etiology
Sleep Apnea, Central* / therapy
Treatment Outcome