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Won - Figure 39

Mechanism: High Loop Gain

FIG. 39:  TE-CSA has been attributed to high loop gain, and the number of central apneas during PAP titration seems to be related to or predicted by the loop gain measure.[33-35]  When loop gain is measured, patients with the high loop gain are more likely to have persistent CSA.  Therefore, those who develop TE-CSA have a vey unstable ventilatory control system. 

Won C. Chest 2016;00.

References

[33]

Loewen A, Ostrowski M, Laprairie J, Atkar R, Gnitecki J, Hanly P, Younes M. Determinants of ventilatory instability in obstructive sleep apnea: inherent or acquired? Sleep 2009;32:1355–1365. 

[34]

Salloum A, Rowley JA, Mateika JH, et al. Increased propensity for central apnea in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure. Am J Respir Crit Care Med 2010;181:189–193. 

[35]

Stanchina M, Donat W, Corrao W, et al. Clinical use of loop gain measures to determine CPAP efficacy in patients with complex sleep apnea: a pilot study, Ann Am Thoracic Soc. 2015,12:1351-1357.