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.Objectives: To determine the immediate response to CPAP in combined obstructive and central sleep apnea patients without heart failure.Methods: Thirty 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.Results: On 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).Conclusion: CPAP 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