2.50
Hdl Handle:
http://hdl.handle.net/10755/211653
Type:
Research Study
Title:
FREQUENCY AND PREDICTORS OF COMPLEX SLEEP APNEA
Abstract:
Purpose/Aims: 1) To determine whether any identifiable baseline clinical and/or physiological characteristics predict the emergence of complex sleep apnea syndrome (CSAS) in patients referred to the University of Utah Sleep-Wake Center, and 2) To determine the frequency of CSAS in these patients using full night diagnostic and titration polysomnograms as well as split night polysomnograms. Background: There is increasing evidence that classifying sleep-disordered breathing as simply either obstructive or central in nature may be an oversimplification of both pathophysiology and clinical reality. There has been increasing recognition of a phenomenon now commonly referred to as CSAS. This is found in patients with obstructive sleep apnea (OSA) in whom continuous positive airway pressure (CPAP) eliminates the obstructive events but elicits periodic breathing with a central sleep apnea (CSA) index > 5 events/hr.  Thus, the clinically troublesome nature of refractory complex disease often becomes evident when attempting to effectively manage patients who do not respond well to traditional CPAP therapy. Methods: The target population is adult patients referred to the University of Utah Sleep-Wake Center with a diagnosis of OSA. In this retrospective study, the medical record information relevant to sleep disordered breathing was examined on a total of 545 consecutive adult patients > 21 years of age, regardless of gender, with a diagnosis of OSA. Patients were diagnosed with OSA if the sum of obstructive apneas and hypopneas per hour was 5 or greater. Patients who have OSA during the diagnostic polysomnogram recording will be considered to have CSAS if the CPAP titration eliminates obstructive events, but the central apnea index is 5 or more per hour of sleep during titration. The data to be examined will include demographics, body mass index, and diagnostic and titration polysomnogram data obtained from both full-night and split-night studies. Results: Of our sample of 545 total subjects, 11.6% (n=63) were classified as having  CSAS during their titration study. The only polysomnogram  features that were statistically predictive for CSAS were hypopnea index measured during the diagnostic study (p=0.03) and the total sleep time measured during CPAP titration (p=0.0003). Significantly more males than females met the diagnostic criteria for complex sleep apnea (p=0.009), and compared to those individuals having full-night polysomnogram  studies, significantly more subjects having split-night polysomnograms had complex sleep apnea (p=0.009) – the difference being significant even when controlling for age (p=0.005). Implications: The prevalence of  CSAS at the University of Utah Sleep-Wake Center is in line with that seen at other sleep centers reported in published literature. The fact that we found CSAS to be more common in those subjects getting split-night studies may have implications for management of patients diagnosed with OSA.
Keywords:
Complex sleep apnea; CSAS; Prediction
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5651
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleFREQUENCY AND PREDICTORS OF COMPLEX SLEEP APNEAen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211653-
dc.description.abstractPurpose/Aims: 1) To determine whether any identifiable baseline clinical and/or physiological characteristics predict the emergence of complex sleep apnea syndrome (CSAS) in patients referred to the University of Utah Sleep-Wake Center, and 2) To determine the frequency of CSAS in these patients using full night diagnostic and titration polysomnograms as well as split night polysomnograms. Background: There is increasing evidence that classifying sleep-disordered breathing as simply either obstructive or central in nature may be an oversimplification of both pathophysiology and clinical reality. There has been increasing recognition of a phenomenon now commonly referred to as CSAS. This is found in patients with obstructive sleep apnea (OSA) in whom continuous positive airway pressure (CPAP) eliminates the obstructive events but elicits periodic breathing with a central sleep apnea (CSA) index > 5 events/hr.  Thus, the clinically troublesome nature of refractory complex disease often becomes evident when attempting to effectively manage patients who do not respond well to traditional CPAP therapy. Methods: The target population is adult patients referred to the University of Utah Sleep-Wake Center with a diagnosis of OSA. In this retrospective study, the medical record information relevant to sleep disordered breathing was examined on a total of 545 consecutive adult patients > 21 years of age, regardless of gender, with a diagnosis of OSA. Patients were diagnosed with OSA if the sum of obstructive apneas and hypopneas per hour was 5 or greater. Patients who have OSA during the diagnostic polysomnogram recording will be considered to have CSAS if the CPAP titration eliminates obstructive events, but the central apnea index is 5 or more per hour of sleep during titration. The data to be examined will include demographics, body mass index, and diagnostic and titration polysomnogram data obtained from both full-night and split-night studies. Results: Of our sample of 545 total subjects, 11.6% (n=63) were classified as having  CSAS during their titration study. The only polysomnogram  features that were statistically predictive for CSAS were hypopnea index measured during the diagnostic study (p=0.03) and the total sleep time measured during CPAP titration (p=0.0003). Significantly more males than females met the diagnostic criteria for complex sleep apnea (p=0.009), and compared to those individuals having full-night polysomnogram  studies, significantly more subjects having split-night polysomnograms had complex sleep apnea (p=0.009) – the difference being significant even when controlling for age (p=0.005). Implications: The prevalence of  CSAS at the University of Utah Sleep-Wake Center is in line with that seen at other sleep centers reported in published literature. The fact that we found CSAS to be more common in those subjects getting split-night studies may have implications for management of patients diagnosed with OSA.en_GB
dc.subjectComplex sleep apneaen_GB
dc.subjectCSASen_GB
dc.subjectPredictionen_GB
dc.date.available2012-02-20T12:06:31Z-
dc.date.issued2012-02-20T12:06:31Z-
dc.date.accessioned2012-02-20T12:06:31Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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