ARTICLE IN PRESS Sleep Medicine ■■ (2015) ■■–■■
Contents lists available at ScienceDirect
Sleep Medicine j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / s l e e p
Original Article
Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m Maria Angelica Bazurto Zapata a,b,*, William Martinez-Guzman a,b, Leslie Vargas-Ramirez a,b, Karen Herrera a, Mauricio Gonzalez-Garcia a,c a
Sleep Center, Fundacion Neumologica Colombiana, Bogota, Colombia School of Medicine, Universidad de La Sabana, Bogota, Colombia c Research Department, Fundacion Neumologica Colombiana, Bogota, Colombia b
A R T I C L E
I N F O
Article history: Received 29 May 2014 Received in revised form 15 September 2014 Accepted 19 September 2014 Available online Keywords: Central sleep apnea Complex sleep apnea Positive airway pressure Sleep disorder breathing Altitude
A B S T R A C T
Background: The occurrence of central apneas when applying positive pressure (CPAP) to patients with obstructive sleep apnea syndrome (OSAS) is called complex sleep apnea (CompSA). This causes poor adherence to CPAP and persistence of symptoms. In Bogota, a city located at an altitude of 2640 m above sea level, chronic hypoxemia can generate certain instability of the respiratory system during sleep which could increase the presence of central apnea. The aim was to establish the prevalence of central apnea (central apnea index >5/h) in adults with moderate or severe OSAS during CPAP titration, and the factors associated with this. Method: Patients over 18 years old with OSAS were referred to the Fundacion Neumologica Colombiana Sleep Center, from January 2008 to June 2010. Polysomnogram (PSG) for CPAP titration was performed according to the American Academy of Sleep Medicine criteria. The prevalence was calculated and the clinical and baseline PSG factors associated with the CompSA were analyzed. Results: We included 988 patients, 58% men. CompSA prevalence was 11.6%. Factors associated with CompSA were: central apneas in the baseline PSG (OR: 5.34 [3.49–8.16]), history of heart failure (OR: 2.53 [1.58– 4.07]), and male sex (OR: 1.68 [1.06–2.69]). Conclusion: The prevalence of complex sleep apnea in Bogota (11.6%) was intermediate compared to the reported in lower altitudes. The factors associated with the development of CompSA were male sex, heart failure, and the presence of central apnea in the baseline PSG. © 2014 Elsevier B.V. All rights reserved.
1. Introduction Obstructive sleep apnea–hypopnea syndrome (OSAS) is a common condition in adults. In a study of four cities in Latin America, the general population had a prevalence of symptoms suggestive of OSAS in 4.6% of men and 2.7% of women [1]. In a population-based study in Sao Paulo (Brazil), an apnea–hypopnea index (AHI) 5/h and those with a central apnea index ≤5/h at baseline polysomnogram. To assess the association between complex apnea with anthropometric and the baseline polysomnogram variables, a logistic regression model was constructed using the variables that showed a p-value 5/h vs those with central apnea index ≤5/h at baseline PSG, those
Table 1 Characteristics and baseline polysomnographic findings in the groups with and without complex apnea (CompSA).
Age, years Neck circumference, cm BMI, kg/cm2 ESS AHI, n/h CAI, n/h OAI, n/h CAI REM, n/h CAI no-REM, n/h SE, % S3, % REM, % Mean SpO2 during events, %
Without CompSA (n = 873)
CompSA (n = 115)
p-Value
59.0 (50.0–67.0) 40.0 (37.0–42.2) 30.8 (27.7–35.0) 10.0 (6.0–16.0) 41.8 (27.5–62.7) 0.6 (0.1–2.5) 39.1 (25.7–59.5) 0.0 (0.0–0.9) 0.6 (0.0–2.7) 78.0 (65.9–86.4) 13.9 (7.2–20.2) 15.3 (10.6–20.0) 81.0 (77.0–85.0)
57.0 (48.0–66.0) 41.0 (38.0–44.0) 29.7 (27.0–33.9) 10.0 (6.0–15.0) 49.7 (36.0–72.9) 5.3 (1.6–14.7) 41.3 (30.4–59.6) 0.6 (0.0–2.3) 5.8 (1.7–16.2) 76.5 (63.3–85.7) 15.1 (7.2–22.9) 15.5 (11.6–19.2) 82.0 (78.0–87.0)
0.217 0.028 0.154 0.851 0.001
Contents lists available at ScienceDirect
Sleep Medicine j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / s l e e p
Original Article
Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m Maria Angelica Bazurto Zapata a,b,*, William Martinez-Guzman a,b, Leslie Vargas-Ramirez a,b, Karen Herrera a, Mauricio Gonzalez-Garcia a,c a
Sleep Center, Fundacion Neumologica Colombiana, Bogota, Colombia School of Medicine, Universidad de La Sabana, Bogota, Colombia c Research Department, Fundacion Neumologica Colombiana, Bogota, Colombia b
A R T I C L E
I N F O
Article history: Received 29 May 2014 Received in revised form 15 September 2014 Accepted 19 September 2014 Available online Keywords: Central sleep apnea Complex sleep apnea Positive airway pressure Sleep disorder breathing Altitude
A B S T R A C T
Background: The occurrence of central apneas when applying positive pressure (CPAP) to patients with obstructive sleep apnea syndrome (OSAS) is called complex sleep apnea (CompSA). This causes poor adherence to CPAP and persistence of symptoms. In Bogota, a city located at an altitude of 2640 m above sea level, chronic hypoxemia can generate certain instability of the respiratory system during sleep which could increase the presence of central apnea. The aim was to establish the prevalence of central apnea (central apnea index >5/h) in adults with moderate or severe OSAS during CPAP titration, and the factors associated with this. Method: Patients over 18 years old with OSAS were referred to the Fundacion Neumologica Colombiana Sleep Center, from January 2008 to June 2010. Polysomnogram (PSG) for CPAP titration was performed according to the American Academy of Sleep Medicine criteria. The prevalence was calculated and the clinical and baseline PSG factors associated with the CompSA were analyzed. Results: We included 988 patients, 58% men. CompSA prevalence was 11.6%. Factors associated with CompSA were: central apneas in the baseline PSG (OR: 5.34 [3.49–8.16]), history of heart failure (OR: 2.53 [1.58– 4.07]), and male sex (OR: 1.68 [1.06–2.69]). Conclusion: The prevalence of complex sleep apnea in Bogota (11.6%) was intermediate compared to the reported in lower altitudes. The factors associated with the development of CompSA were male sex, heart failure, and the presence of central apnea in the baseline PSG. © 2014 Elsevier B.V. All rights reserved.
1. Introduction Obstructive sleep apnea–hypopnea syndrome (OSAS) is a common condition in adults. In a study of four cities in Latin America, the general population had a prevalence of symptoms suggestive of OSAS in 4.6% of men and 2.7% of women [1]. In a population-based study in Sao Paulo (Brazil), an apnea–hypopnea index (AHI) 5/h and those with a central apnea index ≤5/h at baseline polysomnogram. To assess the association between complex apnea with anthropometric and the baseline polysomnogram variables, a logistic regression model was constructed using the variables that showed a p-value 5/h vs those with central apnea index ≤5/h at baseline PSG, those
Table 1 Characteristics and baseline polysomnographic findings in the groups with and without complex apnea (CompSA).
Age, years Neck circumference, cm BMI, kg/cm2 ESS AHI, n/h CAI, n/h OAI, n/h CAI REM, n/h CAI no-REM, n/h SE, % S3, % REM, % Mean SpO2 during events, %
Without CompSA (n = 873)
CompSA (n = 115)
p-Value
59.0 (50.0–67.0) 40.0 (37.0–42.2) 30.8 (27.7–35.0) 10.0 (6.0–16.0) 41.8 (27.5–62.7) 0.6 (0.1–2.5) 39.1 (25.7–59.5) 0.0 (0.0–0.9) 0.6 (0.0–2.7) 78.0 (65.9–86.4) 13.9 (7.2–20.2) 15.3 (10.6–20.0) 81.0 (77.0–85.0)
57.0 (48.0–66.0) 41.0 (38.0–44.0) 29.7 (27.0–33.9) 10.0 (6.0–15.0) 49.7 (36.0–72.9) 5.3 (1.6–14.7) 41.3 (30.4–59.6) 0.6 (0.0–2.3) 5.8 (1.7–16.2) 76.5 (63.3–85.7) 15.1 (7.2–22.9) 15.5 (11.6–19.2) 82.0 (78.0–87.0)
0.217 0.028 0.154 0.851 0.001
