The Prevalence of Central Sleep Apnea in New Referrals to a Sleep Surgery Clinic.

Abstract

Surgical treatment of non-obstructive sleep apnea (OSA) pathology poses the risk of inappropriate surgical indications. Herein, we sought to determine the prevalence of non-OSA respiratory disorders, specifically central sleep apnea (CSA), in new referrals to a Sleep Surgery Clinic. Prospective observational review. Tertiary care academic medical center. In a sleep surgery clinic cohort, the presence of clinically significant CSA was defined as having >25% of the total apnea-hypopnea index (AHI) being central and/or mixed events. Demographics, comorbid disorders, patient-reported outcome measurements, and sleep study results were compared among patients using linear or logistic regression analysis, unadjusted and adjusted for age, sex, and body mass index (BMI). On average, the cohort (n = 295) was male (74%), middle-aged (mean [±SD] 54.2 ± 13.9 years), and overweight (BMI 30.3 ± 5.4), with severe sleep apnea (AHI 30.6 ± 22.6 events/h). Twenty-nine patients (9.8%) were found to have clinically significant CSA yet only 10% of these cases carried a diagnosis of CSA upon presentation. The remainder were identified by reviewing the pre-visit sleep study tables (35%), raw data (17%), and tables and raw data of a repeat post-visit study (38%). Patients with CSA were older and had evidence of more cardiac comorbidities. The prevalence of CSA in new referrals to a Sleep Surgery Clinic was nearly 1 in 10 despite only 1% (3 of 295) with a known diagnosis upon presentation. Sleep surgeons must remain vigilant for patients with occult CSA, especially in older patients with a history of significant cardiovascular disease.