Clinical predictors of central sleep apnea evoked by positive airway pressure titration

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Clinical predictors of central sleep apnea evoked by positive airway pressure titration

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dc.contributor.author Moro, Marilyn en_US
dc.contributor.author Gannon, Karen en_US
dc.contributor.author Lovell, Kathy en_US
dc.contributor.author Merlino, Margaret en_US
dc.contributor.author Mojica, James en_US
dc.contributor.author Bianchi, Matt T en_US
dc.date.accessioned 2016-10-11T20:26:54Z
dc.date.issued 2016 en_US
dc.identifier.citation Moro, Marilyn, Karen Gannon, Kathy Lovell, Margaret Merlino, James Mojica, and Matt T Bianchi. 2016. “Clinical predictors of central sleep apnea evoked by positive airway pressure titration.” Nature and Science of Sleep 8 (1): 259-266. doi:10.2147/NSS.S110032. http://dx.doi.org/10.2147/NSS.S110032. en
dc.identifier.issn 1179-1608 en
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:29002560
dc.description.abstract Purpose Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%–15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management. Methods: We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split-night; n=306 two-night). Demographics and self-reported medical comorbidities, medications, and behaviors as well as standard physiological parameters from the polysomnography (PSG) data were analyzed. We used regression analysis to assess predictors of binary presence or absence of central apnea index (CAI) ≥5 during split-night PSG (SN-PSG) versus full-night PSG (FN-PSG) titrations. Results: CAI ≥5 was present in 24.2% of SN-PSG and 11.4% of FN-PSG patients during titration. Male sex, maximum continuous positive airway pressure, and use of bilevel positive airway pressure were predictors of TECSA, and rapid eye movement dominance was a negative predictor, for both SN-PSG and FN-PSG patients. Self-reported narcotics were a positive predictor of TECSA, and the time spent in stage N2 sleep was a negative predictor only for SN-PSG patients. Self-reported history of stroke and the CAI during the diagnostic recording predicted TECSA only for FN-PSG patients. Conclusion: Clinical predictors of treatment-evoked central apnea spanned demographic, medical history, sleep physiology, and titration factors. Improved predictive models may be increasingly important as diagnostic and therapeutic modalities move away from the laboratory setting, even as PSG remains the gold standard for characterizing primary central apnea and TECSA. en
dc.language.iso en_US en
dc.publisher Dove Medical Press en
dc.relation.isversionof doi:10.2147/NSS.S110032 en
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968988/pdf/ en
dash.license LAA en_US
dc.subject risk en
dc.subject prediction en
dc.subject central apnea en
dc.subject complex apnea en
dc.subject emergent en
dc.subject titration en
dc.title Clinical predictors of central sleep apnea evoked by positive airway pressure titration en
dc.type Journal Article en_US
dc.description.version Version of Record en
dc.relation.journal Nature and Science of Sleep en
dash.depositing.author Mojica, James en_US
dc.date.available 2016-10-11T20:26:54Z

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