Predictors of Initial CPAP Prescription and Subsequent Course with CPAP in Patients with Central Sleep Apneas at a Single Center

• Published in: Lung 2023-12, Vol.201 (6), p.625-634
• Main Authors: Locke, Brian W., Sellman, Jeffrey, McFarland, Jonathan, Uribe, Francisco, Workman, Kimberly, Sundar, Krishna M.
• Format: Article
• Language: English
• Subjects: Analysis; Apnea; Care and treatment; Central Sleep Apnea; Clinical decision making; Clinical Trials as Topic; Continuous Positive Airway Pressure; Development and progression; Diagnosis; Electronic health records; Electronic medical records; Humans; Mechanical ventilation; Medical records; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Narcotics; Patients; Pneumology/Respiratory System; Polysomnography; Regression analysis; Regression models; Sleep; Sleep apnea syndromes; Sleep Apnea, Central - diagnosis; Sleep Apnea, Central - therapy; Sleep disorders; Statistical analysis; Therapy
• ISSN: 0341-2040; 1432-1750; 1432-1750
• DOI: 10.1007/s00408-023-00657-z

Purpose Guidelines recommend considering an initial trial of continuous positive airway pressure (CPAP) to treat central sleep apnea (CSA). However, practice patterns vary widely. This study investigated predictors for an initial trial of CPAP in patients with central apneas and whether those factors predict adequate treatment response in patients receiving an initial CPAP trial. Methods Charts of patients receiving a diagnostic code for CSA following a sleep study during 2016–2018 at a single center were reviewed. Patient factors, initial treatment prescriptions, and subsequent changes to therapy were extracted from electronic health records. Regression models were used to estimate factors associated with an initial CPAP prescription and the likelihood of an adequate CPAP response (no subsequent therapy change and no discontinuation of therapy) among patients prescribed CPAP. Results 429/588 (73%) patients with central apneas received an initial trial of CPAP. Younger age, diagnosis by home sleep testing, non-opiate etiology of central apneas, and a lower proportion of central apneas at diagnosis were independently associated with a higher likelihood of an initial CPAP trial. A lower proportion of central apneas was associated with a higher probability of adequate response, while current smoking and opiate-related central apneas predicted an unsuccessful CPAP trial. A new finding was that older age predicted a lower likelihood of an initial CPAP prescription but did not predict an unsatisfactory response to CPAP. Conclusion Clinicians may incorrectly weigh certain clinical and sleep study characteristics when deciding whether to trial CPAP for patients with central apneas.