Role of continuous positive airway pressure in patients with combined sleep apnea syndrome without congestive heart failure

Continuous positive airway pressure (CPAP) is a standard treatment of moderate and severe obstructive sleep apnea syndrome. However, its effect in patients with coexisting obstructive and central apneas is controversial.ObjectivesTo determine the immediate response to CPAP in combined obstructive and central sleep apnea patients without heart failure.MethodsThirty seven consecutive patients with moderate and severe coexisting obstructive and central apneas (combined group) were prospectively enrolled in this cross sectional analytic study. All patients underwent a full night-attended and a full night CPAP titration polysomnography. Titration was considered successful if AHI < 10 and the titration study included at least 15 min in REM stage.ResultsOn CPAP titration, the combined group showed significant improvement in sleep and respiratory polysomnographic parameters. Mean AHI was reduced from 71.9 ± 30.3 to 8.39 ± 5.15 (P = 0.000). Whereas CPAP significantly reduced the central apnea index from 12.8 ± 6.67 to 3.1 ± 2.86 (P = 0.000), the response to central events was variable (ranged from 20% to 100%). Overall results, 25 (67.6%) had successful titration with significant better response in females than males to CPAP than males (88.9% vs. 60.7%, P = 0.019).ConclusionCPAP can be effective in combined obstructive and central apnea patients without heart failure with consideration of individual variability. A trial of CPAP titration should be done in those patients.