ADVERTISEMENT

Issue Navigator

Volume 09 No. 11
Earn CME
Accepted Papers
Classifieds







Scientific Investigations

Air Leak during CPAP Titration as a Risk Factor for Central Apnea

http://dx.doi.org/10.5664/jcsm.3166

Sydney B. Montesi, M.D.1,2; Jessie P. Bakker, Ph.D.1; Mary Macdonald3; Lauren Hueser, M.S.B.M.E.3; Stephen Pittman, M.S.B.M.E.3; David P. White, M.D., F.A.A.S.M.1,3; Atul Malhotra, M.D., F.A.A.S.M.1,4
1Sleep Disorders Research Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; 2Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA; 3Philips Respironics, Boston, MA; 4 Division of Pulmonary and Critical Care Medicine, UCSD, San Diego, CA

Objectives:

Emergence of central sleep apnea has been described in the setting of continuous positive airway pressure (CPAP) initiation. The underlying mechanism is unclear; however, we postulate that air leak washing out anatomical dead space is a contributing factor.

Design:

Data were obtained from 310 patients with obstructive sleep apnea (OSA) who underwent either split-night or full-night CPAP titration during January to July of 2009. The majority (n = 245) underwent titration with a nasal mask. Average total leak and maximum total leak were measured at therapeutic CPAP level. Unintentional leak was calculated by subtracting manufacturer-defined intentional leak from maximum leak.

Results:

Subjects were divided into two groups: central apnea index (CAI) during titration < 5/hour and ≥ 5/hour. The groups were similar in terms of gender, age, BMI, and AHI. The CAI < 5 group had a median average leak of 45.5 L/min (IQR 20.8 L/min) versus 51.0 L/min (IQR 21.0 L/min) with CAI ≥ 5 (p = 0.056). Maximum leak was 59.5 L/min (IQR 27.0 L/min) with CAI < 5 and 75.0 L/min (IQR 27.8 L/min) with CAI ≥ 5 (p = 0.003). In the subset of subjects titrated using a nasal mask, median average leak was 42.0 L/min (IQR 17.0) in the CAI < 5 group and 50.0 L/min (IQR 16.8) in the CAI ≥ 5 group (p = 0.001). In the CAI < 5 group, median maximum leak was 57.0 L/min (IQR 23.0) versus 74.5 L/min (IQR 24.3) in the CAI ≥ 5 group (p < 0.001).

Conclusions:

Leak during CPAP titration is associated with the development of acute central apnea; these data may have mechanistic and therapeutic implications for complex apnea.

Commentary:

A commentary on this article appears in this issue on page 1193.

Citation:

Montesi SB; Bakker JP; Macdonald M; Hueser L; Pittman S; White DP; Malhotra A. Air leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med 2013;9(11):1187-1191.




Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership