Debunking Myths about Treatment Emergent Central Sleep Apnea

Abstract

Treatment Emergent Central Sleep Apnea (TECSA) is a polysomnographic phenomenon whereby there is emergence of new central respiratory events (central apneas and hypopneas) after preexisting obstructive events have mostly resolved while patient is being titrated with positive airway pressure (PAP) therapy [1]. The acronym TECSA was first used by Nigam et al. in 2016 while describing the prevalence and risk factors related to central sleep apnea developing instantaneously with PAP use [2]. They found that the aggregate point prevalence of TECSA is around 8% while the estimated range varies from 5% to 20% in patients with untreated OSA [2]. This phenomenon can occur at any CPAP setting including very low pressure settings [3]. Few years later, Nigam et al. in a sentinel paper demonstrated that TECSA may not always be transient after all. While most cases of newly identified TECSA resolve in few weeks to few months of PAP use, this is not true for all cases. In a rigorous systematic review, they found that about a third of patients with TECSA may continue to exhibit persistence of PAP related central apneas on re-evaluation [4]. A small proportion may experience what they call delayed-TECSA (DTECSA), referring to patients that do not show TECSA on first titration but go on to develop TECSA few weeks to several months after initial exposure to PAP therapy [4,5].