Dados do Trabalho

Título

The importance of titration of positive pressure devices in the treatment of obstructive sleep apnea – emergence of central sleep apnea (TECSA)

Introdução

The first choice for the treatment of severe and moderate Obstructive Sleep Apnea Syndrome (OSAS) are positive airway pressure (PAP) devices. Even with optimal treatment pressure titration, central events may increase or arise in some patients. Treatment-Emergent Central Sleep Apnea (TECSA), also called Complex Apnea, occurs in 5-15% of OSAS patients on PAP therapy. Clinical predictors are not well understood in the development of TECSA, thus noting that some characteristics such as higher central apnea index, lower SpO2, high loop gain phenotype, lower sleep efficiency, lower N3 sleep stage and higher sleep and REM latencies can be observed, both in diagnostic polysomnography and in titration polysomnography.

Objetivo

To emphasize the importance of titration of PAP devices, in order to try to minimize the risk of TECSA.

Métodos

Data were obtained from the patient's medical record, authorized and signed by the patient in the informed consent form.

Resultados

Female, 47 years old, BMI 50.43 kg/m², with severe bronchial asthma, bipolar disorder for 15 years, using lithium, quetiapine and clonazepam. She has been snoring, witnessed apneas, daytime hypersomnolence and worsening dyspnea (mMRC 4) for 2 years. Diagnostic polysomnography with an AHI of 15.7/hour with obstructive events with oxyhemoglobin desaturations (35% of TST with SpO2 < 90%) and an awakening rate of 30/hour. Indicated for VPAP titration in the sleep laboratory. The patient returned with slurred speech and attention deficit for the last15 days after starting the use of automatic VPAP, with factory settings, 1.5 months ago, without having performed the requested PAP titration. Reading the VPAP card showed the appearance of TECSA. After adjusting the pressures, there was an improvement in the symptoms and resolution of TECSA.

Conclusões

In this case, initiation of VPAP was associated with the development of cognitive symptoms that may be related to the appearance of TECSA. The acquisition of PAPs, without proper titration of the ideal pressures for the treatment, is increasingly frequent due to purchase over the internet, without a prescription, and can lead to an increase in the prevalence of TECSA. Therefore, sleep laboratory titration should remain the gold standard to minimize risk, especially in patients with predisposing factors.

Palavras -chave

Obstructive Sleep Apnea; Central Sleep Apnea; Continuous Positive Airway Pressure.