Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2013
Authors: Kuźniar TJ, Kasibowska-Kuźniar K, Ray DW, Freedom T,
The definition of complex sleep apnea (CompSAS) encompasses patients with obstructive sleep apnea (OSA) who develop central apnea activity upon restitution of airway patency. Presence of arterial hypertension (HTN), coronary artery disease (CAD) and heart failure (HF) have been proposed as risk factors for CompSAS among OSA patients. Using our database of patients with CompSAS, we examined the prevalence of these risk factors and defined other clinical characteristics of patients with CompSAS.
Through retrospective search of the database, we examined the medical and clinical characteristics of consecutive patients diagnosed with CompSAS between 11/1/2006 and 6/30/2011 at NorthShore University HealthSystem.
One hundred and fifty patients with CompSAS were identified. Among patients included in the study, 97 (64.7 %) had at least one risk factor for CompSAS, while 53 (35.3 %) did not have any of them. Prevalence of low left ventricular ejection fraction and hypocapnia were low. Therapeutic interventions consisted of several positive airway pressure therapies, mainly adaptive servo ventilation. A hundred and ten patients (73.3 %) complied with recommended therapy and improved clinically.
Although most patients with CompSAS have cardiac comorbidities, about one third of patients do not have any risk factors of CompSAS prior to sleep testing. Further research on factors involved in development of CompSAS will allow for better tailoring of therapy to pathophysiology involved in an individual case.
PMID: 24235902 [PubMed - as supplied by publisher]
Pneumonologia i alergologia polska 2012
Authors: Anderson M, Kuźniar TJ,
Nocardiosis is an infrequent but potentially serious pulmonary infection that typically affects patients with immune suppression or structural lung disease. We report a case of a 70-year-old patient with chronic obstructive pulmonary disease (COPD) treated with inhaled steroids, theophylline, short-acting beta-agonists and anticholinergics, and long-term oxygen therapy, who presented with non-resolving pneumonia. Following a diagnosis of nocardiosis, made based on sputum culture, the patient was treated with trimethoprim/sulphamethoxazole and then, due to treatment side effects, with minocycline. We review the literature data on nocardiosis in COPD patients.
PMID: 23109210 [PubMed - as supplied by publisher]
Chest 2012 Oct
Authors: Kuźniar TJ, Morgenthaler TI,
Complex sleep apnea syndrome (CompSAS) describes the coexistence or appearance and persistence of central apneas or hypopneas in patients with obstructive sleep apnea upon successful restoration of airway patency. We review data on treatment of CompSAS with CPAP, bilevel positive airway pressure, and adaptive servoventilation and discuss evidence for the addition of medications (analgesics, hypnotics, acetazolamide) and gases (oxygen, CO2) to positive airway pressure therapy. Future research should focus on defining outcomes in patients with CompSAS and allow for more accurate tailoring of therapy to the pathophysiology present in the individual patient.
PMID: 23032455 [PubMed - as supplied by publisher]
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2012 Jun 15
Authors: Goldstein C, Kuzniar TJ,
By the current definition, complex sleep apnea (CompSA) refers to the emergence of central sleep apnea (CSA) during the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). However, new-onset CSA has been described with use of other treatments for OSA, including tracheostomy, maxillofacial surgery, and mandibular advancement device. We present a patient with CSA beginning after endoscopic sinus and nasal surgery for nasal obstruction in the setting of mild OSA. This case highlights the importance of non-PAP mechanisms in the pathogenesis of CompSA.
PMID: 22701391 [PubMed - as supplied by publisher]
Pneumonologia i alergologia polska 2012
Authors: Kuźniar TJ, Kasibowska-Kuźniar K, Freedom T,
Patients with complex sleep apnoea (CompSAS) have obstructive sleep apnoea and experience persistent central apnoeas when exposed to positive airway pressure. Elevated loop gain is one of the postulated mechanisms of CompSAS. We speculated that bilevel positive airway pressure - spontaneous (BPAP-S), by producing relative hyperventilation, may more readily produce CompSAS activity than continuous positive airway pressure (CPAP). If found to do so, a trial of BPAP-S might be a simple way of identifying patients with elevated loop gain who are at risk for CompSAS.
Thirty-nine patients with complex sleep apnoea were included in the study. Segments of NREM sleep on CPAP and BPAP-S matched for body position and expiratory airway pressure (comparison pressure) were retrospectively analysed. Correlations between clinical and demographic variables and polysomnographic response to CPAP and BPAP-S were sought.
There was no difference in any of the polysomnographic indices on CPAP and BPAP-S. In 19 patients the use of CPAP was associated with lower AHI at the comparison pressure; in 20 patients the opposite was true. No clinical variables correlated to the differential response to CPAP vs. BPAP-S.
BPAP-S was not more effective than CPAP in stimulating complex sleep apnoea activity.
PMID: 22562273 [PubMed - as supplied by publisher]
Sleep & breathing = Schlaf & Atmung 2012 Sep
Authors: Kuzniar TJ, Patel S, Nierodzik CL, Smith LC,
Servo ventilation (SV) devices generate positive airway pressure with a variable pressure support that changes in response to a patient's own respiratory output. Two currently available SV devices-VPAP-AdaptSV® and BIPAP-AutoSV®-have been used in treatment of complex sleep apnea (CompSAS), but no side-by-side comparisons are available.
Data of 76 consecutive patients with complex sleep apnea, who were prescribed a VPAP-AdaptSV® or BIPAP-AutoSV® in a non-randomized parallel design, were retrospectively analyzed. Patients underwent a diagnostic polysomnogram followed by a continuous positive airway pressure (CPAP) titration and a SV titration study. Objective compliance with the device was assessed at the first visit at 4-6weeks of its use.
Thirty-five patients received a VPAP-AdaptSV® device, while 41 patients were treated with BIPAP-AutoSV®. Patients treated with BIPAP-AutoSV® had a significantly higher apnea-hypopnea index during their CPAP titration study than patients treated with VPAP-AdaptSV® [49/h (28-60) vs. 35/h (19.5-49.5), median (interquartile range), p<0.001]. On follow-up, 56 patients (73.7%) were using their device. Mean nightly use was 5.0h (2.8-6.4) for VPAP-AdaptSV® group and 6.0h (3.5-7.2) for BIPAP-AutoSV® group (p=0.081); an improvement in Epworth Sleepiness Scale score was higher in the BIPAP-AutoSV® group than in the VPAP-AdaptSV® group [4 (1-9) vs. 2.5 (0-5), p=0.02].
Our retrospective data indicate that the two servo-ventilation devices are comparable means of controlling complex sleep apnea, and the compliance with them is high.
PMID: 21960462 [PubMed - as supplied by publisher]