Periodic breathing in patients with stable obstructive sleep apnea on long-term continuous positive airway pressure treatment: a retrospective study using CPAP remote monitoring data

Abstract

Purpose The purpose of this study was to investigate the rate of periodic breathing (PB) and factors associated with the emergence or persistence of PB in patients with obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) remote monitoring data. Methods This was a retrospective cohort study on 775 patients who had used the same model CPAP machine for at least 1 year as of September 1, 2020. The data were analyzed online using the dedicated analysis system. Using exporter software, average apnea/hypopnea index (AHI), average central apnea index (CAI), and average the rate of PB time (PB%) were cited. Results Among 618 patients analyzed (age 61.7 ± 12.2 years, male 89%, BMI 27.2 ± 4.9), the average duration of CPAP use was 7.5 ± 4.0 years. The median PB% in stable patients was low at 0.32%, and only 149 patients (24%) had a PB% above 1%. Multiple regression analysis of factors for the development of PB showed that the most important factor was atrial fibrillation (Af) with a coefficient of 0.693 (95% CI; 0.536 to 0.851), followed by QRS duration with a coefficient of 0.445 (95% CI; 0.304 to 0.586), followed by history of heart failure, male sex, comorbid hypertension, obesity, and age. The average PB% for paroxysmal Af was significantly lower than that for persistent and permanent Af. Conclusions The median PB% in stable patients on CPAP treatment was low at 0.32%, with only 24% of patients having PB% ≥ 1%. Persistent Af and an increase in QRS duration were found to be important predictors of increased PB%. Clinical trial registration UMIN000042555 2021/01/01.

Cheyne-Stokes Breathing as a Predictive Indicator of Heart Failure in Patients With Obstructive Sleep Apnea; A Retrospective Case Control Study Using Continuous Positive Airway Pressure Remote Monitoring Data

“…In our previous study based on the monitoring data from the CPAP device, 83.3% of the emergence group, which included patients whose CSB% was <1% at the time of diagnosis but subsequently increased to 2% or higher over time, experienced at least one of the following events during the period from polysomnography at the time of diagnosis to analyses of the CPAP device data: new onset or relapse of HF, cerebral infarction, and Af, as well as diastolic dysfunction and increased QRS duration. Left ventricular ejection fraction was 45% or higher in all patients (13).…”

“…Based on the CPAP remote monitoring data, we previously examined the percentage of CSB duration during sleep (CSB%) in 618 patients with stable OSA who were on CPAP for extended periods (13). The median CSB% was as low as 0.32%, while 149 patients (24.1%) had a CSB% of 1% or higher.…”