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

Dominik Linz, Maximilian Valentin Malfertheiner, Nils Werner, Christoph Lerzer, Florian Gfüllner, Benedikt Linz, Florian Zeman, R. Doug McEvoy, Michael Arzt, Mathias Baumert

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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.

Original language	English
Pages (from-to)	62-70
Number of pages	9
Journal	Sleep Medicine
Volume	79
DOIs	https://doi.org/10.1016/j.sleep.2021.01.007
Publication status	Published - Mar 2021

Keywords

Adaptive servo-ventilation
Continuous positive airway pressure
Heart failure
Oximetry
Sleep apnea
Sleep-disordered breathing

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title = "Nocturnal hypoxemic burden during positive airway pressure treatment across different central sleep apnea etiologies",

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 (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.",

keywords = "Adaptive servo-ventilation, Continuous positive airway pressure, Heart failure, Oximetry, Sleep apnea, Sleep-disordered breathing",

author = "Dominik Linz and Malfertheiner, {Maximilian Valentin} and Nils Werner and Christoph Lerzer and Florian Gf{\"u}llner and Benedikt Linz and Florian Zeman and McEvoy, {R. Doug} and Michael Arzt and Mathias Baumert",

year = "2021",

month = mar,

doi = "10.1016/j.sleep.2021.01.007",

language = "English",

volume = "79",

pages = "62--70",

journal = "Sleep Medicine",

issn = "1389-9457",

publisher = "Elsevier B.V.",

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TY - JOUR

T1 - Nocturnal hypoxemic burden during positive airway pressure treatment across different central sleep apnea etiologies

AU - Linz, Dominik

AU - Malfertheiner, Maximilian Valentin

AU - Werner, Nils

AU - Lerzer, Christoph

AU - Gfüllner, Florian

AU - Linz, Benedikt

AU - Zeman, Florian

AU - McEvoy, R. Doug

AU - Arzt, Michael

AU - Baumert, Mathias

PY - 2021/3

Y1 - 2021/3

N2 - 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.

AB - 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.

KW - Adaptive servo-ventilation

KW - Continuous positive airway pressure

KW - Heart failure

KW - Oximetry

KW - Sleep apnea

KW - Sleep-disordered breathing

UR - http://www.scopus.com/inward/record.url?scp=85099610301&partnerID=8YFLogxK

U2 - 10.1016/j.sleep.2021.01.007

DO - 10.1016/j.sleep.2021.01.007

M3 - Article

C2 - 33482454

AN - SCOPUS:85099610301

SN - 1389-9457

VL - 79

SP - 62

EP - 70

JO - Sleep Medicine

JF - Sleep Medicine

ER -

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

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Keywords

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