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VOLUME 36, ISSUE 08

RANDOMIZED CONTROLLED TRIAL OF CPAP-INDUCED CENTRAL SLEEP APNEA
Randomized Controlled Trial of Noninvasive Positive Pressure Ventilation (NPPV) Versus Servoventilation in Patients with CPAP-Induced Central Sleep Apnea (Complex Sleep Apnea)

http://dx.doi.org/10.5665/sleep.2878

Dominic Dellweg, MD; Jens Kerl, PhD; Ekkehard Hoehn; Markus Wenzel, MD; Dieter Koehler, PhD

Kloster Grafschaft, Pulmonary Medicine I, Home Mechanical Ventilation Unit and Sleep Laboratory, Schmallenberg, Germany



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Study Objectives:

To compare the treatment effect of noninvasive positive pressure ventilation (NPPV) and anticyclic servoventilation in patients with continuous positive airway pressure (CPAP)-induced central sleep apnea (complex sleep apnea).

Design:

Randomized controlled trial.

Setting:

Sleep center.

Patients:

Thirty patients who developed complex sleep apnea syndrome (CompSAS) during CPAP treatment.

Interventions:

NPPV or servoventilation.

Measurements and Results:

Patients were randomized to NPPV or servo-ventilation. Full polysomnography (PSG) was performed after 6 weeks. On CPAP prior to randomization, patients in the NPPV and servoventilator arm had comparable apnea-hypopnea indices (AHI, 28.6 ± 6.5 versus 27.7 ± 9.7 events/h (mean ± standard deviation [SD])), apnea indices (AI,19 ± 5.6 versus 21.1 ± 8.6 events/h), central apnea indices (CAI, 16.7 ± 5.4 versus 18.2 ± 7.1 events/h), oxygen desaturation indices (ODI,17.5 ± 13.1 versus 24.3 ± 11.9 events/h). During initial titration NPPV and servoventilation significantly improved the AHI (9.1 ± 4.3 versus 9 ± 6.4 events/h), AI (2 ± 3.1 versus 3.5 ± 4.5 events/h) CAI (2 ± 3.1 versus 2.5 ± 3.9 events/h) and ODI (10.1 ± 4.5 versus 8.9 ± 8.4 events/h) when compared to CPAP treatment (all P < 0.05). After 6 weeks we observed the following differences: AHI (16.5 ± 8 versus 7.4 ± 4.2 events/h, P = 0.027), AI (10.4 ± 5.9 versus 1.7 ± 1.9 events/h, P = 0.001), CAI (10.2 ± 5.1 versus 1.5 ± 1.7 events/h, P < 0.0001)) and ODI (21.1 ± 9.2 versus 4.8 ± 3.4 events/h, P < 0.0001) for NPPV and servoventilation, respectively. Other sleep parameters were unaffected by any form of treatment.

Conclusions:

After 6 weeks, servoventilation treated respiratory events more effectively than NPPV in patients with complex sleep apnea syndrome.

Citation:

Dellweg D; Kerl J; Hoehn E; Wenzel M; Koehler D. Randomized controlled trial of noninvasive positive pressure ventilation (NPPV) versus servoventilation in patients with CPAP-induced central sleep apnea (complex sleep apnea). SLEEP 2013;36(8):1163-1171.

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