M. Safwan Badr, MD: Novel Treatments for Central Sleep Apnea in Last 10 Years

Three groups of studies on central sleep apnea (CSA) treatments have emerged in the past 10 years, falling under the topics of adaptive servo-ventilation, hypochlorite phrenic nerve stimulation, and pharmacological intervention.

At SLEEP 2024, the 38th annual meeting of the Associated Professional Sleep Societies, M. Safwan Badr, MD, from Wayne State University, told HCPLive the morphologic differences between CSA and obstructive sleep apnea (OSA) and the novel treatments for CSA. Badr also shared the challenges of these novel treatments and the future developments of new treatment options.

For a while, patients with CSA used adaptive servo ventilation but that came to a halt 9 years ago when a study revealed this treatment option increased mortality. A 2023 study led by Doug Bradley rebutted this, eliminating the concern adaptive servo-ventilation increases mortality. Clinicians could safely return to identifying patients who would benefit from adaptive servo-ventilation.

“It's a novel and a useful contribution to the field,” Badr said. “I always want to see a situation where the clinician is able to make the best decision in partnership with the patient, and I think this would be this would be a step in that direction.”

Emerging studies on hypochlorite phrenic nerve stimulation for CSA treatment have shown promising results with improvement in respiratory events, patient-reported outcomes, and quality of life.

As for the third group of emerging studies—pharmacological interventions—research shows the older medication acetazolamide may be helpful for patients who have a high propensity to CSA. It is currently being studied in patients with sleep disorders breathing broadly with high loop pain, which has a high propensity of CSA. A pharmacological approach could be helpful for those who are developing CSA because something is turning off their mid-respiratory center in the medulla,

“If we can develop a pharmacological intervention that will prevent that from happening. Imagine the lives that will be saved,” Badr said.

Although these novel treatments exist or are being evaluated, Badr said he always likes to start with traditional therapy like CPAP which works for 50% to 60% of patients. If a patient does not respond, he will try an alternate treatment option, such as adaptive servo-ventilation or supplemental oxygen.

“We shouldn't be rushing, bypassing all the treatments that we know work in favor of a magic pill because we do not know what the long-term effect of this magic pill is,” Badr said. “At the end of the day, we need to start with the patient and end with the patient. Our job is to actually serve [them]. The patient is giving us the honor [of] involving us in life decisions related to their health.”

References

^{Derman, C. M. Safwan Badr, MD: What are the Novel Treatments for Central Sleep Apnea? HCPLive. June 10, 2024. https://www.hcplive.com/view/m-safwan-badr-md-what-are-the-novel-treatments-for-central-sleep-apnea-. Accessed July 3, 2024.}