A retrospective case series of adaptive servoventilation for complex sleep apnea.

STUDY OBJECTIVES: Central sleep apnea can be refractory to traditional positive airway pressure (PAP) therapy (CPAP or bilevel PAP), whether appearing first as a feature of baseline polysomnography or only later once PAP is applied in what is termed "complex sleep apnea" (CompSA). This retrospective study examined the efficacy of adaptive servoventilation (ASV) in 25 consecutive patients with PAP-refractory central sleep apnea, most exhibiting predominantly obstructive apnea during baseline polysomnography. METHODS: Patient characteristics were: age = 59.8 ± 16.5 yr; BMI = 30.4 ± 6.1 kg/m(2); apnea/hypopnea index (AHI) = 48.5 ± 30.2/h; and central apnea index (CAI) = 10.8 ± 16.0/h. Following unsuccessful PAP titrations, patients underwent ASV titration. Eighteen met established criteria for CompSA. RESULTS: On traditional PAP, AHI did not improve significantly compared to baseline, whether based on the entire titration (38.5 ± 23.4/h, p = 0.10) or the final PAP pressure(s) (44.4 ± 25.9/h, p = 0.54); CAI tripled across the titration (27.4 ± 23.5/h, p = 0.001) and at the final pressure(s) (34.8 ± 24.2/h, p < 0.001). On ASV, AHI fell to 11.4 ± 8.2/h across the titration (p < 0.001) and decreased further to 3.6 ± 4.2/h at the optimal end expiratory pressure (p < 0.001). AHI was ≤ 5/h in 80% of patients and < 10/h in 92%. ASV virtually eliminated central apneas at optimal end expiratory pressure (0.7 ± 2.2/h, p < 0.001). Respiratory arousals showed parallel improvements on ASV but not PAP. CONCLUSIONS: ASV proved superior to traditional PAP in reducing the AHI, CAI, and respiratory arousals in a heterogeneous patient group with sleep disordered breathing in whom central apneas emerged or persisted on PAP.

Mother-infant bedsharing is associated with an increase in infant heart rate.

OBJECTIVES: We hypothesized that mother-infant bed sharing, compared to solitary sleeping, would be associated with higher infant heart rates. The objective was to compare infant heart rates between the 2 environments and, secondarily, to test for relationships between heart rate and other, previously reported, differences in the same infants. DESIGN: Heart rate was measured in 15 infants over a bed-sharing night and a solitary-sleeping night. Eight of the 15 infants routinely bed shared with the mother at home; the other 7 routinely slept in a room alone. SETTING: The Sleep Disorders Center, University of California, Irvine Medical Center. PARTICIPANTS: Fifteen mother-infant pairs who met criteria for routinely bed sharing or sleeping solitarily. All were healthy, and infants were more than 38 weeks gestation at birth and 11 to 15 weeks old at the time of the study. INTERVENTIONS: None. RESULTS: Analysis of variance indicated that, irrespective of routine sleeping condition, heart rate was lower during solitary sleeping than during bed sharing in all sleep stages. Significant regressions were found with infant temperature. Heart-rate variability was higher during solitary sleeping than during bed sharing (both routine groups) in stages 1 and 2 and rapid eye movement sleep, but only stages 1 and 2 sleep effects were independent of basal heart rate. CONCLUSIONS: Infant heart rate is affected by the mother's presence in the sleep environment. The increase in sympathetic activity in stages 3 and 4 and rapid eye movement sleep might be partly explained by differences in thermoregulation between bed-sharing and solitary-sleeping environments. These results support the notion that sensory differences between bed-sharing and solitary-sleeping environments account for some of the physiologic differences between infant sleep in the 2 sleeping conditions.