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Clinical management of patients with sleep breathing disorder: obstructive sleep apnea and central sleep apnea with Cheyne Stokes breathing
Central apnea is defined as > 90% reduction in oronasal flow for at least 10 seconds associated with loss of respiratory effort, while in obstructive apnea effort is observed even during the absence of flow. When a central apnea is associated with Cheyne Stokes breathing, it has risk factors for CHF, stroke, and renal failure. The treatment is with positive pressure devices.
To analyze or therapeutic management with positive pressure devices in patients with obstructive sleep apnea and central sleep apnea with Cheyne Stokes breathing.
Male, 70 years old, insomnia and snoring for 1 year, in addition to excessive daytime sleepiness, breathing interruptions, frequent awakenings. Has hypertension, heart failure. STOP - BANG of 7; Epworth scale of 13. Submitted to polysomnography type 1 that shows an apnea and hypopnea index of 110.92/h with predominance of central apnea and crescendo-decrescendo breathing pattern.
A new polysomnography was performed for CPAP titration, where an optimal pressure of 10cmH₂O with event resolution was determined. Epworth is reapplied after 1 month of treatment, scoring 8.
The CPAP device is an initial option for central apnea because upper airway obstruction is important in the pathophysiology of hypercapnic and non-hypercapnic central apnea.
Positive bilevel ventilation exacerbates central apnea and periodic breathing.
Adaptive servo-ventilation (ASV) devices compatible with expiratory, inspiratory support, and responses that consider variation in ventilation or flow may be used and are primarily designed for patients with non - hypercapnic central apnea. Treatment with ASV is more tolerated than CPAP and is effective in suppressing central apnea, improving oxygenation in the presence of heart failure. Regarding sleep quality, sleepiness and quality of life there is not much difference between the adaptive servo-ventilation and CPAP.
In patients with central apnea, appropriate pressure therapy is essential to prevent worsening of sleep disordered breathing.
obstructive sleep apnea; central sleep apnea; cheyne stokes breathing; continuous positive airway pressure; adaptive servo-ventilation, bilevel positive airway pressure.
Relato de Caso
Priscila Silva Monteiro