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healthy_backТо есть, классика с дисплазией вообще и УАРС в частности - при отсутствии этиологического лечения (расширения дыхательных путей) происходит просто обмен одной проблемы на другую.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725531/?fbclid=IwAR2CGSMCKLNNpU-_coEXQGe9ZxSQ8HU-90p2LehKf8saCFqn46z44u_1H4s
Chin Med J (Engl). 2020 Nov 20; 133(22): 2721–2730.
Published online 2020 Sep 30. doi: 10.1097/CM9.0000000000001125
PMCID: PMC7725531
PMID: 33009018
Treatment-emergent central sleep apnea: a unique sleep-disordered breathing
Jing Zhang, Le Wang, Heng-Juan Guo, Yan Wang, Jie Cao, and Bao-Yuan Chen
Abstract
Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
Introduction
Treatment-emergent central sleep apnea (TECSA, formerly complex sleep apnea) describes the appearance of central sleep apnea (CSA) and/or hypopnea while undergoing treatment for obstructive sleep apnea (OSA).[1] TECSA was observed in some patients who primarily had OSA or mixed apneas after the significant resolution of the obstructive events by treatment with a positive airway pressure (PAP) device without a back-up rate.[2,3] TECSA has recently been observed after various treatment modalities for OSA, including the use of a mandibular advancement device (MAD), maxillomandibular advancement surgery, sinus and nasal surgery, and tracheostomy.[4–9] In some TECSA cases, occurrence of CSA events during initial continuous positive airway pressure (CPAP) titration are transient and they may resolve spontaneously with chronic CPAP therapy.[10] However, some central apneas persist even with regular CPAP therapy.[10] The development of TECSA has affected the effectiveness of OSA treatment and patients’ compliance with it.[2,11] Therefore, in order to analyze this condition properly, several studies on TECSA have recently been conducted. However, there is still some controversy regarding the prevalence of TECSA and the optimal treatment method for it, and its importance and significance have not yet been fully established. This review aimed to summarize the definition, epidemiology, potential mechanisms, and clinical characteristics of TECSA, and review the treatment methods for it.
Definition
TECSA refers to a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for OSA such as using PAP therapy.[1] Gilmartin et al[12] first described this phenomenon using the new term “complex sleep-disordered breathing.” Then, Morgenthaler et al[13] termed this type of sleep-disordered breathing “complex sleep apnea syndrome (CompSAS).” The International Classification of Sleep Disorders-third edition introduced the term “TECSA” as a new name for this phenomenon; it is defined as the presence of primary OSA at the initial diagnostic sleep study, significant resolution of obstructive events with CPAP titration but emergence or persistence of central events during PAP treatment with a central apnea index (CAI) ≥5/h, greater than 50% of events being central, and the symptoms cannot be better explained by another CSA disorder.[1] However, new-onset CSA has also been reported during other non-CPAP treatments for OSA, including surgery and the use of oral appliances. Goldstein and Kuzniar[9] reported a 43-year-old man with mild OSA developed CSA after endoscopic sinus and nasal surgery for nasal obstruction. The patient's nasal congestion improved, but night-time sleep fragmentation and excessive daytime sleepiness both worsened 4 months after surgery in this case; he had not gained any weight and did not have any cardiopulmonary symptoms. Some studies have reported that other surgical interventions, such as tracheostomy and maxillomandibular advancement, resulted in the appearance of CSA post-operatively.[8,14,15] Mohan et al[4] noted a patient with moderate OSA who used a MAD initially, had CSA. The spontaneous resolution of MAD-emergent CSA was observed in this patient 1 year after MAD treatment. There have been three reports on the occurrence of similar MAD-emergent CSA during treatment with a MAD.[5–7] Therefore, the definition of TECSA should refer to the phenomenon of transient and/or persistent CSA after not only CPAP treatment but also all kinds of therapy for OSA.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725531/?fbclid=IwAR2CGSMCKLNNpU-_coEXQGe9ZxSQ8HU-90p2LehKf8saCFqn46z44u_1H4s
Chin Med J (Engl). 2020 Nov 20; 133(22): 2721–2730.
Published online 2020 Sep 30. doi: 10.1097/CM9.0000000000001125
PMCID: PMC7725531
PMID: 33009018
Treatment-emergent central sleep apnea: a unique sleep-disordered breathing
Jing Zhang, Le Wang, Heng-Juan Guo, Yan Wang, Jie Cao, and Bao-Yuan Chen
Abstract
Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
Introduction
Treatment-emergent central sleep apnea (TECSA, formerly complex sleep apnea) describes the appearance of central sleep apnea (CSA) and/or hypopnea while undergoing treatment for obstructive sleep apnea (OSA).[1] TECSA was observed in some patients who primarily had OSA or mixed apneas after the significant resolution of the obstructive events by treatment with a positive airway pressure (PAP) device without a back-up rate.[2,3] TECSA has recently been observed after various treatment modalities for OSA, including the use of a mandibular advancement device (MAD), maxillomandibular advancement surgery, sinus and nasal surgery, and tracheostomy.[4–9] In some TECSA cases, occurrence of CSA events during initial continuous positive airway pressure (CPAP) titration are transient and they may resolve spontaneously with chronic CPAP therapy.[10] However, some central apneas persist even with regular CPAP therapy.[10] The development of TECSA has affected the effectiveness of OSA treatment and patients’ compliance with it.[2,11] Therefore, in order to analyze this condition properly, several studies on TECSA have recently been conducted. However, there is still some controversy regarding the prevalence of TECSA and the optimal treatment method for it, and its importance and significance have not yet been fully established. This review aimed to summarize the definition, epidemiology, potential mechanisms, and clinical characteristics of TECSA, and review the treatment methods for it.
Definition
TECSA refers to a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for OSA such as using PAP therapy.[1] Gilmartin et al[12] first described this phenomenon using the new term “complex sleep-disordered breathing.” Then, Morgenthaler et al[13] termed this type of sleep-disordered breathing “complex sleep apnea syndrome (CompSAS).” The International Classification of Sleep Disorders-third edition introduced the term “TECSA” as a new name for this phenomenon; it is defined as the presence of primary OSA at the initial diagnostic sleep study, significant resolution of obstructive events with CPAP titration but emergence or persistence of central events during PAP treatment with a central apnea index (CAI) ≥5/h, greater than 50% of events being central, and the symptoms cannot be better explained by another CSA disorder.[1] However, new-onset CSA has also been reported during other non-CPAP treatments for OSA, including surgery and the use of oral appliances. Goldstein and Kuzniar[9] reported a 43-year-old man with mild OSA developed CSA after endoscopic sinus and nasal surgery for nasal obstruction. The patient's nasal congestion improved, but night-time sleep fragmentation and excessive daytime sleepiness both worsened 4 months after surgery in this case; he had not gained any weight and did not have any cardiopulmonary symptoms. Some studies have reported that other surgical interventions, such as tracheostomy and maxillomandibular advancement, resulted in the appearance of CSA post-operatively.[8,14,15] Mohan et al[4] noted a patient with moderate OSA who used a MAD initially, had CSA. The spontaneous resolution of MAD-emergent CSA was observed in this patient 1 year after MAD treatment. There have been three reports on the occurrence of similar MAD-emergent CSA during treatment with a MAD.[5–7] Therefore, the definition of TECSA should refer to the phenomenon of transient and/or persistent CSA after not only CPAP treatment but also all kinds of therapy for OSA.