Complex Sleep Apnea Treatment Challenges：复杂的睡眠呼吸暂停治疗的挑战.ppt

Comparison VPAP Adapt ASV (n=35) Avg use 5.0 Change ESS -2.5 % nights 4 h 67 CMS compliant % 34 BIPAP Auto ASV (n=41) 6.0 -4 73.5 51 Reference 3 Patient T.Y. On ASV Therapeutic Challenges Adaptive Servo Ventilation costly nCPAP may eventually be adequate therapy. Other therapies not well studied. Conclusions/ Suggestions Clinicians caring for all OSA pts need proper training/ education given prevalence and natural history of Complex SA. Difficult to predict patients who will develop the syndrome. Prevalence of the syndrome highlights importance of CPAP titration study in OSA patients. Conclusions/ Suggestions (cont) Treatment decision generally pertains to ? ASV vs close f/u on CPAP Insurance carriers may impact on these decisions Suggest confirming emergent CAs prior to ASV titration Consider 02 and pharmacologic agents Need to consider best therapy for pt, but sensitive to costs (CPAP titration/ ASV) For More Info: References 1. Javaheri The prevalence and Natural History of Complex Sleep Apnea JCSM No 3, 2009 205-211 2. Hoffman The Appearance of Central Sleep Apnea after Treatment of Obstructive Sleep Apnea Chest Aug 2012 517-522 3. Kuzniar Comparison of two servo ventilator devices in the treatment of complex sleep apnea Sleep Medicine (2011) 2010.09.017 4. Nakazaki Continuous positive airway pressure intolerance associated with elevated nasal resistance is a possible mechanism of complex sleep apnea Sleep Breath (2012) 16:747-752 References 5 Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes. Chest. 2007 Dec; 132 (6): 1839-1846. PMID: [PubMed – indexed for MEDLINE] 6. CPAP should be used for central sle