The Sleep Disorders Channel is supported through educational grants from Alkermes and Takeda.
VJNeurology is an independent medical education platform. Channel supporters have no influence over the production of content.
Treatment selection in CSA: when to switch, add on or reconsider therapy
M. Safwan Badr, MD, Wayne State University School of Medicine, Detroit, MI, discusses treatment selection in central sleep apnea (CSA), highlighting the need for future comparative effectiveness studies. Prof. Badr explains that continuous positive airway pressure (CPAP) is generally the starting point, with adaptive servo-ventilation (ASV) or bilevel positive airway pressure (BPAP) with a backup rate considered for patients who do not respond. He emphasizes that, beyond this, management should be individualized and guided by patient response, clinical experience and disease pathophysiology. This interview was recorded on a virtual conference call with VJNeurology.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
Well, this is where the guidelines don’t give us guidance on this one because it was based on studies comparing a treatment versus no treatment. So one of the opportunities for the future is to have comparative effectiveness studies. We have nothing to compare, say, CPAP with acetazolamide. That’s just as an idea. So the general treatment approach is for most of us is we start with CPAP...
Well, this is where the guidelines don’t give us guidance on this one because it was based on studies comparing a treatment versus no treatment. So one of the opportunities for the future is to have comparative effectiveness studies. We have nothing to compare, say, CPAP with acetazolamide. That’s just as an idea. So the general treatment approach is for most of us is we start with CPAP. And again, part of the reason is the majority of patients have comorbid obstructive apnea. We treat and then we see how they respond. Somewhere about 50% of the patients will respond. And in that case, we’re done. If not, we have to think of alternative therapies. This is where ASV or BPAP with a backup rate come in the picture. Now, in certain situations, and this is where, again, we’re individualizing, we may choose to give, if payers allow, or if there’s hypoxia, we may choose to give supplemental oxygen in addition to CPAP. But here we are no longer guided by guidelines. We’re actually guided by our own clinical experience and understanding the pathophysiology. And then the follow-up is always, is the patient responding? And what we tend to do, we bring the patient back and we look at the download. Are they responding to the treatment or are they not? And if they’re not responding to the treatment, then we can either add another medication or another intervention or switch. Now, patients who have predominantly central apnea and they haven’t responded or they haven’t tolerated anything, and we are in a referral center where we have the procedure, then phrenic nerve stimulation is an option. But though we tend to make it a secondary, given the fact that it’s costly and invasive, it requires an intervention. So, at the end of the day, management of central apnea has to be individualized and it’s a challenge for all of us of how we individualize it. But that’s kind of the general outline.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
