826 Central Sleep Apnea associated with Sodium Oxybate– A Case Series

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A322-A322
Author(s):  
Subhendu Rath ◽  
Lizabeth Binns ◽  
Neeraj Kaplish
Keyword(s):  
Sleep Apnea ◽  
Sleep Onset ◽  
Case Series ◽  
Central Sleep Apnea ◽  
Sodium Oxybate ◽  
Close Monitoring ◽  
Sleep Study ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep ◽  
Titration Study

Abstract Introduction Sodium oxybate (SO) is indicated to treat cataplexy and excessive daytime sleepiness (EDS) in patients with narcolepsy. Only a handful of cases have been reported of new-onset Central Sleep Apnea (CSA) in the setting of SO use. We present 3 patients who developed CSA in the setting of use of SO. Report of case(s) Patient 1: A 25-y/o man presented with hypersomnolence. His diagnostic polysomnogram (PSG) showed moderate Obstructive Sleep Apnea (OSA), and he was placed on Continuous Positive Airway Pressure (CPAP) therapy. Due to persistent hypersomnia in the setting of effectively treated OSA, he had a Multiple Sleep Latency Test (MSLT), which revealed pathological sleepiness with a mean latency of 3.8 minutes with a sleep-onset REM on the overnight polysomnogram. SO was started for clinical diagnosis of Narcolepsy after he failed other stimulant medications. Hypersomnolence improved though data from his PAP device, home sleep studies, re-titration studies performed when he was on SO demonstrated CSA following 1st or 2nd dose of SO. Patient 2: A 17-y/o man was diagnosed to have Narcolepsy with Cataplexy, based on PSG followed by MSLT. 20 years later, he was diagnosed with OSA based on a PSG and was treated with CPAP. A few years later, he was started on SO for fragmented sleep and EDS. A home sleep study performed when he was on SO, revealed CSA. Later, an in-lab titration study showed CSA with Cheyne-Stokes respiration (CSR), treated with Adaptive Servo-Ventilation (ASV) therapy. Patient 3: A 15-y/o man initially presented after several cataplectic episodes and was diagnosed with Narcolepsy with Cataplexy. His initial PSG showed no evidence of sleep-disordered breathing. A few years later, for persistent cataplectic events, he was started on SO with improvement in the episodes’ frequency. Several years later, a baseline PSG demonstrated OSA and CSA, with frequent CSA events soon after taking SO. The CPAP titration study, performed following the PSG, also revealed frequent CSA following the second dose of SO. Conclusion Close monitoring is warranted with SO use, given some narcolepsy patients’ predisposition to develop CSA. Follow-up studies are needed to address the pathogenesis and management strategies. Support (if any) None

860 Variable Sleep Apnea Syndromes Complicated by Neurosurgeries in a Patient with Chiari Malformation Type 1

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A334-A335
Author(s):  
Ashwin Ananth ◽  
Elie Fares ◽  
Emily Sagalow ◽  
Swetha Nemargamulla ◽  
Zhanna Fast
Keyword(s):  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Decompression Surgery ◽  
Close Monitoring ◽  
Obstructive Sleep ◽  
Advanced Therapies ◽  
Complex Sleep Apnea ◽  
Titration Study

Abstract Introduction Chiari malformations (CM) are congenital conditions defined by craniocervical junction anatomic anomalies with downward displacement of cerebellar structures. Sleep-disordered breathing (SDB) including obstructive sleep apnea (OSA), bradypnea, central sleep apnea (CSA), and hypoventilation are described in CM patients. Report of case(s) 31-year-old male with history of CM type 1 presented to the sleep medicine clinic for management of OSA and CSA diagnosed at age 16. PSG showed an apnea-hypopnea index (AHI) of 14.2, RDI of 29, and no central events. He was started on auto-CPAP with pressures of 5–20 with subsequent visits showing high residual AHI. A subsequent CPAP-titration study resulted in a pressure of 16cm H2O yielding AHI of 0. CPAP pressure was fixed, but a high residual AHI persisted despite excellent compliance. A split-night study resulted in a BiPAP prescription, for which a titration study noted PAP-emergent CSA. He was started on auto Bilevel with IPAP of 30, EPAP of 8 and backup rate of 12bpm. Despite treatment, elevated AHI persisted so he was switched to adaptive servo-ventilation (ASV) with nightly oxygen blended in resulting in controlled complex sleep apnea. SDB management was complicated by multiple neurosurgical decompressions. During the most recent procedure, he was found to have syringomyelia, syringobulbia, and a mass at the brainstem. Surgery, including placement of a 4th ventricle stent and mass excision, initially led to a decrease of residual AHI to a low of 0.7, before progressively increasing to 15. A repeat PSG demonstrated severe OSA (AHI of 35), without evidence of CSA or nocturnal hypoventilation. ASV was resumed and patient’s AHI progressively decreased to an average of 8, with improvement in his sleep apnea symptoms. Conclusion SDM in CM patients can be explained by condition-related anatomical changes and depression of respiratory centers due to possible extrinsic compression leading to complex sleep apnea presentations. While it is unclear why this patient’s sleep apnea improved then worsened after his latest decompression surgery, we believe that CSF recirculation and postoperative inflammation may be responsible. Close monitoring of SDB in patients with CM is important as they may require advanced therapies for proper control. Support (if any):

scholarly journals 1244 A Curious Case of ASV Failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A474-A474
Author(s):  
Nishant Chaudhary ◽  
Mirna Ayache ◽  
John Carter
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Neck Extension ◽  
Sleep Study ◽  
Obstructive Sleep

Abstract Introduction Positive airway pressure-induced upper airway obstruction has been reported with the treatment of obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP) along with an oronasal interface. Here we describe a case of persistent treatment emergent central sleep apnea (TECSA) inadequately treated with adaptive servo ventilation (ASV), with an airflow pattern suggestive of ASV-induced upper airway obstruction. Report of Case A 32-year-old male, with severe OSA (apnea hypopnea index: 52.4) and no other significant past medical history, was treated with CPAP and required higher pressures during titration sleep studies to alleviate obstructive events, despite a Mallampati Class II airway and a normal body mass index. Drug-Induced Sleep Endoscopy (DISE) showed a complete velopharynx and oropharynx anterior posterior (AP) collapse, long soft palate, which improved with neck extension. CPAP therapy, however, did not result in any symptomatic benefit and compliance reports revealed high residual AHI and persistent TECSA. He underwent an ASV titration sleep study up to a final setting of expiratory positive airway pressure 9 cm H2O, pressure support 6-15 cm H2O (auto-rate), with a full-face mask due to high oral leak associated with the nasal interface. The ASV device detected central apneas and provided mandatory breaths, but did not capture the thorax or abdomen, despite normal mask pressure tracings. Several such apneas occurred, with significant oxyhemoglobin desaturation. Conclusion We postulate that the ASV failure to correct central sleep apnea as evidenced by the absence of thoracoabdominal inspiratory effort, occurred due to ASV-induced upper airway obstruction. Further treatment options for this ASV phenomenon are to pursue an ASV-assisted DISE and determine the effectiveness of adjunctive therapy including neck extension, nasal mask with a mouth closing device and a mandibular assist device.

scholarly journals 0956 Vitamin D and Sleep in Children

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A363-A363
Author(s):  
B Al-Shawwa ◽  
Z Ehsan ◽  
D G Ingram
Keyword(s):  
Vitamin D ◽  
Sleep Apnea ◽  
Vitamin D Deficiency ◽  
Sleep Duration ◽  
Tertiary Care ◽  
Central Sleep Apnea ◽  
Sleep Efficiency ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
The Impact

Abstract Introduction The impact of vitamin D on human health including sleep has been well described in adults. Its deficiency has been associated with multiple sleep disorders such as decrease in sleep duration, worsening of sleep quality and even obstructive sleep apnea. Such correlation is less evident in pediatric population. In the current study, we examined the relationship between sleep architecture and vitamin D status in children referred to a sleep clinic. Methods Retrospective-cohort study in a tertiary care children’s hospital over a one-year period. Children who underwent an in-laboratory-overnight-polysomnogram and had a 25-hydroxy vitamin D level (25-OH-vitD) obtained within 120 days of the sleep study were included. Patients with obstructive or central sleep apnea were excluded. Data from polysomnograms (PSG) and Pediatric Sleep Questionnaires (PSQ) were collected and analyzed. Results A total of 39 patients were included in the study with mean age of 6.6 years and 46% females. Twenty (51%) patients had vitamin D deficiency (25-OH-vitD less than 30 ng/ml). Children with vitamin D deficiency had less total sleep time (470.3 minutes +/-35.6 vs 420.3 minutes +/-61.7, p=0.004) and poorer sleep efficiency (91.9 % +/-5.6 vs 84.5 % +/-9.5, p=0.015) compared to vitamin D sufficient children. In addition, vitamin D deficient children had later weekday bedtimes (21:02 +/- 1:01 vs 20:19 +/- 0:55, p=0.037) and later weekend bedtimes (21:42 +/- 0:59 vs 20:47 +/- 1:08, p=0.016) with tendency for later wake up time that did not reach statistical significance. The remainder of polysomnographic findings and PSQ data were not different between the two groups. Conclusion Vitamin D deficiency in children is associated with objectively measured decreased sleep duration and poorer sleep efficiency. Furthermore, vitamin D deficiency was associated with delayed bedtimes, suggesting that vitamin D may influence circadian rhythm. Future prospective studies in children would be helpful in validating the effect of vitamin D on sleep. Support None

Polysomnography in Pediatric Otolaryngology: If Not Obstructive Sleep Apnea, What Is It?

2017 ◽  
Vol 157 (6) ◽  
pp. 1053-1059 ◽  
Author(s):  
Christine H. Heubi ◽  
Jareen Meinzen-Derr ◽  
Sally R. Shott ◽  
David F. Smith ◽  
and Stacey L. Ishman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disturbances ◽  
Case Series ◽  
Central Sleep Apnea ◽  
Categorical Variables ◽  
Periodic Limb Movements ◽  
Continuous Variables ◽  
Retrospective Case ◽  
Obstructive Sleep

Objective To determine common polysomnographic (PSG) diagnoses for children referred by otolaryngologists. Study Design Retrospective case series with chart review. Setting Single tertiary pediatric hospital (2010-2015). Subjects and Methods Review of the medical records of 1258 patients undergoing PSG by otolaryngology referral. Patients who underwent previous otolaryngologic surgery were excluded. Data distributions were evaluated using means with standard deviations for continuous variables and frequencies with percentages for categorical variables. Results A total of 1258 patients were included; 55.9% were male, 64.5% were Caucasian, 16.6% had Down syndrome, and 48% had public insurance. The median age at the time of PSG was 5.2 years (range = 0.2-18.94). Indications for PSG were sleep-disordered breathing (SDB; 69.4%), restless sleep (12.7%), airway anomalies (7.5%), and laryngomalacia (7.2%). SDB was seen in 73.4%, obstructive sleep apnea (OSA) in 53.2%, OSA + central sleep apnea (CSA) in 4.5%, CSA in 0.9%, and non-OSA snoring in 15%. Other diagnoses included periodic limb movements of sleep (PLMS; 7.4%), hypoventilation (6.8%), and nonapneic hypoxemia (2.6%). SDB was more common in younger children and seen in 91.4% of children <12 months and in 69.2% of children ≥24 months, while non-OSA snoring was more common with increasing age (3.7% in children <12 months, 17.7% of children ≥24 months). PLMS were seen in 8.9% of children ≥24 months and in no children <12 months. Conclusion While OSA and snoring were the most common diagnoses reported, PLMS, alveolar hypoventilation, and CSA occurred in 7.4%, 6.8%, and 5.4%, respectively. These findings indicate that additional diagnoses other than OSA should be considered for children seen in an otolaryngology clinic setting who undergo PSG for sleep disturbances.

Positive airway pressure therapy

2017 ◽  
Author(s):  
Dirk Pevernagie
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Therapeutic Success ◽  
Pressure Therapy ◽  
Cardiovascular Comorbidity ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep

This chapter describes positive airway pressure (PAP) therapy for sleep disordered breathing. Continuous PAP (CPAP) acts as a mechanical splint on the upper airway and is the treatment of choice for moderate to severe obstructive sleep apnea (OSA). Autotitrating CPAP may be used when the pressure demand for stabilizing the upper airway is quite variable. In other cases, fixed CPAP is sufficient. There is robust evidence that CPAP reduces the symptomatic burden and risk of cardiovascular comorbidity in patients with moderate to severe OSA. Bilevel PAP is indicated for treatment of respiratory diseases characterized by chronic alveolar hypoventilation, which typically deteriorates during sleep. Adaptive servo-ventilation is a mode of bilevel PAP used to treat Cheyne–Stokes respiration with central sleep apnea . It is crucial that caregivers help patients get used to and be compliant with PAP therapy. Education, support, and resolution of adverse effects are mandatory for therapeutic success.

840 Obstructive to Central: A switch in sleep apnea type after arteriovenous malformation rupture

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A327-A327
Author(s):  
Meredith Greer ◽  
Lynn Marie Trotti ◽  
Nancy Collop
Keyword(s):  
Sleep Apnea ◽  
Arteriovenous Malformation ◽  
Optic Tract ◽  
Central Sleep Apnea ◽  
Periventricular White Matter ◽  
Cerebral Peduncle ◽  
Sleep Study ◽  
Residual Symptoms ◽  
Decompressive Hemicraniectomy ◽  
Obstructive Sleep

Abstract Introduction Sleep apnea and stroke have long been shown to be linked, with sleep apnea increasing the risk for stroke and stroke leading to sleep apnea. When the latter occurs, it can present as central sleep apnea (CSA), often in the form of Cheyne-Stokes breathing (CSB), and has been shown to resolve over time. We present a patient with persistent CSA after severe hemorrhagic stroke secondary to rupture of a temporal/thalamic arteriovenous malformation (AVM). Report of case(s) A 33-year-old man with a history of obstructive sleep apnea (OSA) presented to our clinic for re-evaluation of his disease. He was diagnosed with OSA in 2006 at which time he was 270 pounds with a body mass index (BMI) of 36.7, thus the OSA was thought to be secondary to obesity. When he presented to our clinic 10 years later, he had lost approximately 80 pounds after suffering multiple strokes. In 2014, he had a left temporal lobe hemorrhage due to rupture of a left temporal/thalamic AVM and required decompressive hemicraniectomy. In 2015, he had a re-bleed of this AVM, with new hemorrhage extending inferiorly into the left cerebral peduncle and pons, and superiorly into the left parietal periventricular white matter anteriorly along the optic tract. Ultimately, he was treated with stereotactic radiotherapy to the AVM nidus with no residual AVM. However, he has chronic encephalomalacia of the left basal ganglia, thalamus, temporal, parietal, and occipital lobes with extension into the left cerebral peduncle and changes consistent with radiation necrosis. His residual symptoms are aphasia and right-sided hemiplegia and although his snoring resolved with weight loss, his mother noticed pauses in his breathing overnight. A repeat sleep study done in 2016 showed 27 central apneas and 0 obstructive apneas with an AHI of 5.4 events/hour. He was subsequently studied on ASV with residual AHI of 0.4 events/hour. Conclusion Although patients with OSA may be at higher risk for stroke, it is important to re-evaluate their sleep apnea after such an event to ensure appropriate diagnosis and treatment going forward. Support (if any):

Central sleep apnea and hypoventilation syndromes

2017 ◽  
Author(s):  
Mithri R. Junna ◽  
Bernardo J. Selim ◽  
Timothy I. Morgenthaler
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Noninvasive Positive Pressure Ventilation ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Positive Pressure ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep ◽  
Alveolar Hypoventilation

Sleep disordered breathing (SDB) may occur in a variety of ways. While obstructive sleep apnea is the most common of these, this chapter reviews the most common types of SDB that occur independently of upper airway obstruction. In many cases, there is concurrent upper airway obstruction and neurological respiratory dysregulation. Thus, along with attempts to correct the underlying etiologies (when present), stabilization of the upper airway is most often combined with flow generators (noninvasive positive pressure ventilation devices) that modulate the inadequate ventilatory pattern. Among these devices, when continuous positive airway pressure (CPAP) alone does not allow correction of SDB, adaptive servo-ventilation (ASV) is increasingly used for non-hypercapnic types of central sleep apnea (CSA), while bilevel PAP in spontaneous-timed mode (BPAP-ST) is more often reserved for hypercapnic CSA/alveolar hypoventilation syndromes. Coordination of care among neurologists, cardiologists, and sleep specialists will often benefit such patients.

Update: Kardiovaskuläre Schlafmedizin

2017 ◽  
Vol 142 (12) ◽  
pp. 912-923
Author(s):  
Benedikt Linz ◽  
Michael Böhm ◽  
Dominik Linz
Keyword(s):  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Systolic Heart Failure ◽  
Central Sleep Apnea ◽  
Underlying Disease ◽  
Adjunct Treatment ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep ◽  
Related Quality ◽  
Health Related

AbstractThe prevalence of sleep-disordered breathing (SDB) is high in patients with cardiovascular diseases. Typical symptoms like daytime sleepiness can be absent and those patients may report unspecific, therapy-resistant symptoms related to their underlying disease. Particularly sleep-related symptoms like nocturia, nocturnal dyspnea and pectangina can be present. Based on the results of recently published studies, the treatment of central sleep apnea in patients with symptomatic, systolic heart failure by adaptive servo-ventilation is no longer recommended. Although the treatment of obstructive sleep apnea did not prevent cardiovascular events, it improved snoring, daytime sleepiness and health-related quality of life. Furthermore, studies imply that treatment of SDB should be considered as an adjunct treatment modality in patients with hypertension and atrial fibrillation. Due to the high prevalence, screening for SDB can help to identify patients at high cardiovascular risk.

scholarly journals Ticagrelor could cause central sleep apnea after acute coronary syndrome in patients without left ventricular dysfunction or heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Meurin ◽  
A Ben Driss ◽  
C Defrance ◽  
N Renaud ◽  
R Dumaine ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Central Sleep Apnea ◽  
Left Ventricular ◽  
Sleep Study ◽  
Coronary Syndrome ◽  
Obstructive Sleep ◽  
History Of

Abstract Background Although the prevalence of obstructive sleep apnea (OSA) syndrome is high in patients with acute coronary syndrome (ACS), little is known about central sleep apnea (CSA) in these patients, especially if they have no left ventricular dysfunction (indeed, it is well known that heart failure could be a confounding factor as it is an important cause of CSA). Furthermore, central apnea could be promoted by ticagrelor, a relatively new drug, already known to cause dyspnea (which could modify the apneic threshold) in some patients. Purpose To investigate the prevalence of central sleep apnea in patients without left ventricular dysfunction after ACS. Methods Monocentric prospective survey. All consecutive patients within 365 days after ACS were included if they had (1) left ventricular ejection fraction LVEF &gt;45%, (2) no history of heart failure, (3) systolic arterial pulmonary artery pressure &lt;45 mm Hg, and (4) no history of sleep apnea. After inclusion, patients underwent an overnight sleep study with a portable sleep monitor validated to differentiate central and obstructive apneas. Patients were then classified as “normal” patients if they had an AHI (apnea hypopnea index) &lt;15, “CSA patients” if they had an AHI &gt;15 with a majority of central sleep apneas and “OSA patients” if they had an AHI &gt;15 with a majority of obstructive sleep apneas. Results Between January 2018 and January, 2020, we included 115 consecutive patients (age 56.1±10.5, male 84%, mean body mass index 28.4±4.5, LVEF: 56±4%). Sleep study was performed 68±62 days (7–350 days) after ACS on average. All of the patients were receiving a single or (mostly) dual antiplatelet therapy: aspirin (n=114: 99%, ticagrelor (n=80: 69.5%), clopidogrel (n=28: 24%), prasugrel (n=4: 3.5%). Finally 80 patients were taking ticagrelor, while 35 were not. A total of 49/115 patients (42.6%) had a clinically significant (moderate to severe) sleep disordered breathing, with an AHI&gt;15: (CSA: n=27/115: 23.5%, OSA:n=22/115: 19%). Among them, 25/115 patients (22%) had a severe (AHI &gt;30) sleep disordered breathing: CSA 12% OSA: 10%. Among patients receiving ticagrelor, 24/80 (30%) had a CSA with an AHI &gt;15, while, in patients not taking ticagrelor only 3/35 (8.5%) had CSA with an AHI &gt;15 (p=0.04) Conclusion As expected, OSA is frequent after ACS, as in all types of coronary artery disease patients. High prevalence of CSA was less expected and seemed to be correlated with ticagrelor administration. This monocentric survey is a preliminary safety signal. Further studies are needed to investigate the exact incidence, the sustainability and the potential consequences of ticagrelor induced central sleep apnea. Funding Acknowledgement Type of funding source: None

scholarly journals 1246 Resolution of Cyclical Ventricular Ectopy with ASV Therapy in a Patient with Cheyne-Stokes Respirations

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A475-A475
Author(s):  
Nawaz Rupani ◽  
Mona Massoud ◽  
Sajeer Bhura ◽  
Neeraj Kaplish
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Arrhythmias ◽  
Structural Changes ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Ventricular Ectopy ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep ◽  
Cheyne Stokes Breathing

Abstract Introduction Nocturnal cardiac arrhythmias, ranging from ventricular ectopy to heart blocks, have been commonly reported in patients with obstructive sleep apnea syndrome (OSAS). Potential mechanisms for these rhythm disturbances include OSA-associated hypoxemia, arousal trigger increased sympathetic activity and alterations in intrathoracic pressures leading to cardiac mechanical structural changes. A beneficial effect of CPAP treatment on rhythm abnormalities in patients with obstructive sleep apnea has also been demonstrated. However, the relationship of cardiac arrhythmias and central sleep apnea is not well established. Report of Case We report an 82-year-old male with CAD and Atrial fibrillation s/p PPM who presented for management of his sleep disordered breathing (SDB). Upon review, his original sleep studies performed at an outside facility revealed obstructive sleep apnea and central sleep apnea with Cheyne-Stokes Respirations. The patient presented to us on treatment with an auto-adjusting PAP (APAP) of 7-15 cmH2O with an average delivered pressure of 12 cmH2O. A re-titration study was recommended and demonstrated persistent central sleep apnea with Cheyne-Stokes breathing despite treatment with CPAP 12-18 cmH2O. During this time, EKG monitoring revealed an atrial paced rhythm with frequent premature ventricular beats (PVBs) which occurred in a cyclical pattern. After initiation of Adaptive Servo-Ventilation (ASV), periodic breathing was well controlled and cyclical ventricular ectopy had completely resolved. Conclusion Although CPAP therapy has been shown to improve nocturnal arrhythmias in patients with obstructive sleep apnea, the same relationship, to our knowledge, has not been reported in patients with central sleep apnea and Cheyne-Stokes breathing. This case demonstrates the improvement of cyclical ventricular ectopy with ASV therapy.

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