Treatment Emergent Central Sleep Apnea: Should We Repeat Titration?

Most patients with Obstructive sleep apnea syndrome are treated with continuous positive airway pressure (CPAP). However, in some patients central apnea arises during CPAP titration. This clinical condition is defined as treatment-emergent central sleep apnea (CSA). Here, we would like to present a case who was diagnosed with treatment-emergent CSA during the first titration study, however CSA was lost in the second titration. Before the diagnosis of treatment-emergent CSA, factors of titration should be reviewed and if it is not found satisfactory, procedure should be repeated. In most cases CPAP therapy eliminates CSA. However, in some cases bilevel positive airway pressure-spontaneous/timed or adaptive servo ventilator is needed. Repeated titration could be useful tool to predict whether the patient needs CPAP or advanced therapies