CRA5 TREATMENT-EMERGENT CENTRAL SLEEP APNEA (TECSA) SUCCESSFULLY TREATED WITH ADAPTIVE SERVO-VENTILATION (ASV) IN A MORBIDLY OBESE OBSTRUCTIVE SLEEP APNEA PATIENT

Jordan Hoo Ching Bing1,  Chai Chan Sin1, Kho Sze Shyang1, Chan Swee Kim1, Siew Teck Tie1 , Yong Mei Ching1
1Respiratory Medicine Unit, Medical Department, Sarawak General Hospital, Kuching, Malaysia

Introduction: 

Treatment-emergent central sleep apnea is characterized by emergence or persistence of central apnea during administration of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) patients. The prevalence of TECSA was reported varies from 2 to 20%. Adaptive servo-ventilation (ASV), a type of ventilatory mode that provide a dynamic adjustment of inspiratory pressure support has shown to be an effective treatment for TECSA.

Case report:

We report a 41-year-old man with BMI 66.4kg/m2 who was initially diagnosed with severe OSA and treated with bi-level positive airway pressure (S-BiPAP) without backup rate therapy since 2015. Unfortunately, he loss to follow up during the coronavirus (COVID) pandemic. 

He returned to follow up in 2021 and complained of increasing daytime sleepiness. The downloaded data showed increasing trend of residual AHI despite good adherence and no significant mask leak. He was put on fixed CPAP and ST-BiPAP therapy but failed improved the residual AHI. 

He underwent repeat diagnostic polysomnography (PSG) that showed severe central sleep apnea. During sleep titration study, central apnea worsened with both CPAP and BiPAP mode while ASV was able to resolve it. Hence, he was diagnosed with treatment-emergent central sleep apnea and initiated with ASV therapy. After ASV therapy for 3 months, his symptoms improved with no increased residual AHI.

Conclusions:

TECSA although uncommon could be a possible cause of residual AHI and sleepiness in patients on PAP therapy. ASV is a valuable therapeutic option when other PAP modalities are not effective.