Treatment-emergent central sleep apnea (TECSA)
Uitgangsvraag
Wat is de beste diagnostische en therapeutische strategie voor TECSA?
Aanbeveling
Start in geval van symptomatisch TECSA behandeling met ASV indien een voldoende lange behandeling met CPAP onvoldoende daling van de AHI heeft bewerkstelligd. Continueer ASV alleen indien het leidt tot een reductie van de AHI en klachten.
Overwegingen
Balans tussen gewenste en ongewenste effecten
Treatment-emergent central sleep apnea (TECSA, vroeger complexe slaapapneu) wordt gezien in 3,5-19,8% van CPAP-behandelde patiënten gezien (Nigam 2018). Delayed‑TECSA (D‑TECSA) is een zeldzaam subtype hiervan die pas met vertraging van weken tot maanden na CPAP-start kan optreden (Nigam 2018).
Er is veel onduidelijkheid over de onderliggende pathofysiologie en de typering wat mogelijk bijdraagt tot deze variabele prevalentie. Voor de mogelijke pathofysiologie, hetgeen niet in deze module wordt besproken, wordt naar de literatuur verwezen (bijvoorbeeld Randerath 2024).
Van TECSA dient treatment-resistant CSA onderscheiden te worden, dus CSA die voor CPAP-behandeling al bestond. De moeilijkheden bij vaststellen van centrale ademevents en vooral het onderscheiden van obstructieve en centrale hypopneus worden in de inleiding en in de diagnostiek gerelateerde module toegelicht.
Het gebruik van te hoge therapiedrukken (overtitratie) kan CSA uitlokken (Randerath 2024). Mannelijk geslacht, een hoge baseline AHI, hogere centrale apneu index, hoge arousal index, opiaat-gebruik en cardiovasculaire comorbiditeit lijken eveneens risicofactoren te zijn (Lehman 2007). Wordt de residuele centrale slaapapneu beter door een andere vorm van CSA verklaard, bijvoorbeeld door atriumfibrilleren en/of hartfalen, dan is er eigenlijk niet sprake van TECSA maar (in dit voorbeeld) van een combinatie van OSA en CSA ten gevolge van deze aandoeningen (ICSD-3-TR). Zie ook de modules rondom de plaats van neurologisch consult/MRI bij CSA en de plaats cardiologisch cardiologisch consult bij CSA voor evaluatie van onderliggende oorzaken.
De overige gevallen van CSA die tijdens OSA-behandeling optreden, de eigenlijke TECSA in engere zin, kan voorbijgaand of persistent zijn (Nigam 2018). Diens beste benadering is de uitgangsvraag en het onderwerp van dit hoofdstuk.
Er werd literatuur gezocht die CPAP-behandeling met andere behandelingen vergelijkt, waaronder ASV. Uit de literatuuranalyse is een uiterst lage opbrengst van 2 studies gekomen, waarvan één observationeel en retrospectief. Deze onderzoeken bieden een zeer laag kwaliteit van bewijs en alleen aanwijzingen voor verbetering van de AHI met ASV ten opzichte van CPAP. In de enige RCT van Morgenthaler (2014) werd na 90 dagen enerzijds niet voldaan aan het vooraf gedefinieerde criterium voor een klinisch relevant verschil in AHI van 10/uur tussen de behandelmodaliteiten. Anderzijds werd het streefdoel van een AHI <10 wel vaker bereikt met ASV (89,7%) dan met CPAP (64,5%).
Een aantal belangrijke kanttekeningen dienen te worden gemaakt:
- Uit onderzoek is gebleken dat TECSA in het merendeel van de gevallen uit zichzelf verdwijnt na continueren van CPAP (Nigam 2018). Dit wordt door de RCT van Morgenthaler (2014) met een follow-up van 90 dagen in beide armen bevestigd. In de literatuur persisteert TECSA in circa een derde van de gevallen met grote variabiliteit (14-46%, ICSD-3-TR). Het is onduidelijk hoelang de patiënten met TECSA in de studie van Allam (2007) zijn behandeld met CPAP alvorens te starten met ASV. Dit kan van grote invloed zijn geweest op de uitkomsten van de studie.
- In beide studies werden patiënten met comorbiditeiten die CSA kunnen induceren niet uitgesloten zoals patiënten met hartfalen, atriumfibrilleren, opiaatgebruik en insomnie. Morgenthaler trachtte met insomnie wel rekening te houden door een residuele CAI met CPAP van 10 per uur te vereisen. Desalniettemin zou verhelpen van OSA met CPAP pre-existente CSA gedemaskeerd kunnen hebben.
Het verschil in kwaliteit van leven tussen ASV en CPAP is door Morgenthaler (2014) onderzocht. Er werd geen verschil in de Sleep Apnea Quality of Life Index (SAQLI) scores en geen significant verschil in de ESS-scores tussen de ASV- en CPAP-groep gevonden.
Er is op basis van de hier geëvalueerde onderzoeken geen bewijs voor verbetering van de kwaliteit van leven met ASV ten opzichte van CPAP.
Kwaliteit van bewijs
De overall kwaliteit van bewijs is zeer laag. Dit betekent dat we zeer onzeker zijn over het gevonden geschatte effect van de cruciale uitkomstmaat, namelijk de AHI.
Er is afgewaardeerd vanwege:
- Risk of Bias: methodologische beperkingen waaronder beperkte informatie over follow-up en mogelijke belangenverstrengeling alsook selectie van patiënten met een persisterend TECSA.
- Imprecisie: onnauwkeurigheid door klein aantal geïncludeerde studies en participanten.
- Observationele aard van geïncludeerde studie(s).
In de “real-world” READ-ASV studie (Arzt 2023), een Europese multicenter cohort studie naar het effect van ASV op kwaliteit van leven en slaperigheid overdag (Functional Outcome of Sleep Questionnaire, FOSQ; Epworth Sleepiness Scale, ESS) werden 801 patiënten onderzocht bij wie ASV werd voorgeschreven voor diverse indicaties (treatment emergent CSA, CSA bij hartlijden, gemengd slaapapneu [OSA/CSA], OSA, CSA in kader van een CVA, idiopathische CSA en CSA door opiaten). ASV werd hoofdzakelijk voor TECSA voorgeschreven (56%) met een gemiddelde (SD) AHI van 49 (+ 23). In symptomatische patiënten op baseline verbeterde ASV de FOSQ en de ESS in klinisch relevante mate.
De ERS statement van 2017 over de behandeling van centrale ademhalingsstoornissen tijdens de slaap stelt vast dat voor ASV getoond werd dat het effectiever treatment-persistent CSA verhelpt dan zuurstof, CPAP, BPAP-ST en NIV (evidence grade B) (Randerath 2017). De werkgroep gebruikte de term treatment-persistent CSA voor nieuw ontstane CSA tijdens behandeling met CPAP of BPAP die persisteerde tijdens continu gebruik. In de ERS- en ESRS-statement van 2025 over de behandeling van CSA met ASV wordt geconcludeerd (Randerath 2025): “. . . if treatment of any underlying disease and a CPAP trial have failed, the members of the panel use ASV for the treatment of symptomatic patients with idiopathic CSA, drug-induced CSA, treatment-emergent CSA, CSA in neurological diseases, CSA in non-cardiac medical disorders, and in HF patients with predominant OSA.”
De AASM richtlijn over de behandeling van CSA bij volwassenen (Badr 2025) beveelt aan ASV te gebruiken bij volwassenen met CSA ten gevolge van de volgende etiologieën: primaire CSA, CSA ten gevolge van hartfalen, CSA ten gevolge van medicatie of middelen, treatment-emergent CSA en CSA ten gevolge van een medische aandoening (laag kwaliteit van bewijs).
Waarden en voorkeuren van patiënten (en eventueel hun naasten/verzorgers)
OSA is een aandoening dat onder andere tot vermoeidheid, overmatige slaperigheid en slapeloosheid kan leiden en het dagelijks functioneren in beduidende mate kan beïnvloeden. Behandeling met CPAP is de standaardtherapie voor ernstige OSA. Het doel, deze OSA-gerelateerde klachten te verhelpen, kan door het optreden van TECSA tegengehouden worden.
Indien TECSA met geoptimaliseerde CPAP-behandeling (al dan niet met zuurstof) onvoldoende daling van de AHI bewerkstelligt en symptomen persisteren, kan een behandeling met ASV wel de gewenste daling van de AHI geven en daarmee ook de klachten reduceren. Voor behandeling van CSA bij hartfalen zie graag het hoofdstuk “ASV in de behandeling van patiënten met CSA en hartfalen”.
Kostenaspecten
De kosten van een CPAP zijn aanzienlijk lager dan van ASV. In deze context is het daarom ook belangrijk bij TECSA eerst een behandeling met CPAP te starten met adequate begeleiding en voldoende tijd te nemen (weken tot maanden) om een spontane afname van de centrale ademevents de kans te geven.
Indien de verbetering niet of onvoldoende volgt, is bij een symptomatische patiënt ASV te rechtvaardigen om klachtenreductie te bewerkstelligen. Dit kan het persoonlijk en maatschappelijk functioneren verbeteren. Er zijn geen gegevens bekend over kostenbesparingen bij TECSA waarvoor ASV.
Gelijkheid ((health) equity/equitable)
De interventie leidt niet tot een toename of afname van gezondheidsgelijkheid want zowel CPAP als ASV wordt vergoed door de zorgverzekeraars.
Aanvaardbaarheid:
Ethische aanvaardbaarheid
De interventie is aanvaardbaar voor de betrokkenen. Er zijn geen ethische bezwaren
Duurzaamheid
Er is geen noemenswaardig verschil tussen CPAP en ASV m.b.t. duurzaamheidsaspecten De levensduur van beide apparaten is vergelijkbaar alsook het gebruik van materialen.
Haalbaarheid
De interventie is in de praktijk al standaardzorg en wordt al ingezet in de zorg voor CSA patiënten in centra voor thuisbeademing en gespecialiseerde slaapcentra. Structurele vergoeding is momenteel alleen voorzien in centra voor thuisbeademing. Echter, de werkgroep is van mening dat deze zorg beter belegd is in gespecialiseerde slaapcentra. Zorgtransitie inclusief verandering van vergoedingssystematiek is nodig. Zie hiervoor verder de module ‘organisatie van zorg’.
Rationale van de aanbeveling: weging van argumenten voor en tegen de interventies
Er is een zwakke aanbeveling om symptomatische patiënten met TECSA behandeld met CPAP, waarbij de AHI onvoldoende gedaald is ondanks voldoende lang (minimaal twee à drie maanden) een spontane daling te hebben afgewacht, te behandelen met ASV. Tevoren zijn factoren die de kans op TECSA vergroten zoals een te hoge CPAP-druk, maskerlekkage en maskerdiscomfort voldoende aangepakt. Zoals in de aanbeveling van module 1 (Slaaptesten voor diagnostiek bij CSA) vermeld, is bij therapiefalen onder CPAP met een persisterend verhoogde AHI (bijvoorbeeld in de CPAP-uitlezing) een PSG aangewezen om te duiden wat de oorzaak is: denk aan druk/maskerproblematiek, een comorbide slaapstoornis [insomnie, RLS/PLMS], maar ook een onterechte diagnose OSA of (treatment emergent/persistent) CSA. De werkgroep ondersteunt de zwakke aanbeveling o.b.v. expert opinion.
Eindoordeel:
Zwakke aanbeveling voor
Onderbouwing
Previously referred to as complex sleep apnea, treatment-emergent central sleep apnea (TECSA) describes the appearance of central sleep apnea (CSA) with treatment of obstructive sleep apnea (OSA). Though usually with continuous positive airway pressure (CPAP) treatment, this phenomenon is also seen with other non-surgical and surgical OSA-treatments (Berger 2021). The prevalence of CPAP-induced CSA is 3.5%–19.8% (Nigam 2018). There is uncertainty regarding the underlying pathophysiology and subtyping to include mixed apnea with treatment-resistant CSA and treatment-emergent CSA has been suggested. Practice variation may also occur due to the appearance of CSA resulting from unduly high CPAP-pressures (over titration) and erroneous classification of CSA as OSA as well as due to variation in therapeutic approaches.
|
Outcome |
Study results and measurements |
Absolute effect estimates |
Certainty of the evidence (Quality of evidence) |
Summary |
|
Apnea-hypopnea index (AHI) (Critical)
|
Based on data from 123 participants in 2 studies
|
A slightly positive effect of ASV on AHI was reported. ASV was superior to CPAP treatment |
Very low Due to serious risk of bias, Due to serious imprecision1 |
The evidence is very uncertain about the effect of ASV on AHI when compared with CPAP in patients with OSA and CPAP-induced CSA.
(Allam 2007; Morgenthaler 2014) |
|
Epworth Sleepiness Scale score (ESS)
|
Based on data from 60 participants in 1 study |
There was a slight improvement of ESS scores in the ASV group compared to the CPAP group
|
Very low Due to serious risk of bias, Due to serious imprecision2 |
The evidence is very uncertain about the effect of ASV on ESS scores when compared with CPAP in patients with OSA and CPAP-induced CSA
(Morgenthaler 2014) |
|
Calgary Sleep Apnea Quality of Life Index (SAQLI) |
Based on data from 60 participants in 1 study |
There was no difference in SAQLI scores reported in the AHI group compared to the CPAP group
|
Very low Due to serious risk of bias, Due to serious imprecision3 |
The evidence is very uncertain about the effect of ASV on SAQLI scores when compared with CPAP in patients with OSA and CPAP-induced CSA.
(Morgenthaler 2014) |
1Risk of Bias: serious. Possible involvement of industry, no clear description of follow-up time. ; Imprecision: serious. Low number of patients; inclusion of patients with comorbidities that may contribute to CSA
2Risk of Bias: serious. Possible involvement of industry; Imprecision: serious. Low number of patients and only one study reported on the outcome;
3Risk of Bias: serious. Possible involvement of industry; Imprecision: serious. Low number of patients and only one study reported on the outcome;
Description of studies and results
A total of 2 studies were included in the analysis of the literature. Important study characteristics and results are summarized in table 2. The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tabellen’).
Allam et al (2007) performed a retrospective chart review of the first 100 consecutive patients in the sleep center who underwent polysomnography to titrate adaptive servoventilation (ASV) after previous unsuccessful continuous positive airway pressure (CPAP) trials. TECSA was diagnosed if CPAP eliminated OSA but the residual central apnea index (CAI) was > 5 or the CSR (Cheyne-Stokes-Respiration) pattern became predominant. Of the 100 patients 63% had complex sleep apnea syndrome (TECSA), 22% CSA and 15% CSA/CSR (Cheyne-Stokes-Respiration CSA). CPAP was performed in 47 patients and ASV in 58 patients. 14 of the TECSA-patients also received a trial with BiLevel-ST and a smaller unreported number of patients in this group were assessed with CPAP + oxygen and with BiLevel-S PAP. PAP interventions with > 60 min of trial time were included for analysis. Treatment efficacy was assessed with changes in residual AHI.
The median baseline (IQR) AHI was 30 (15 – 54), with CPAP 30 (16 – 42) and for ASV 4 (1 – 8.8). The authors reported that BiLevel-S PAP led to a marked increase of AHI and that ASV was superior to all other modalities in reducing the AHI.
Morgenthaler (2014) performed a prospective randomized controlled trial to compare CPAP with ASV therapy for treatment of TECSA. Inclusion of patients was based on: adult OSA patients requiring CPAP ≤ 15 cm H2O to eliminate OSA during PSG-titration, with a residual central apnea index (CAI) > 10 or a predominant and disruptive CSR pattern. A total of 66 patients over six participating centers were randomly assigned to the two treatments. To assess the efficacy of the treatment, change in total apnea-hypopnea index (AHI) from the baseline PSG was compared with the AHI of the last PSG at 90 days. Changes in treatment compliance, ESS and Sleep Apnea Quality of Life Index (SAQLI) were also considered.
Patients received 3-4 attended PSGs and polysomnographic variables were available for 60 participants who completed the study. The CPAP group (n=31) showed a mean AHI of 37.9 ± 29.3 at baseline, 14.1 ± 20.7 at second titration PSG and 9.9 ± 11.1 at the 90-day PSG. The ASV group (n=29) showed a mean AHI of 35.1 (+ 25.3) at baseline, 4.7 ± 8.1 at second titration PSG and 4.4 ± 9.6 at the 90-day PSG. In an intention-to-treat analysis an AHI < 10 was achieved in 26 of 29 (89.7%) ASV patients and in 20 of 31 (64.5%) CPAP patients.
No significant differences between the groups were found for treatment compliance, ESS- and SAQLI-scores. The mean change in ESS score of the ASV group was -2.7 ± 6.1 and for the CPAP group the mean change in ESS score was -2.0 ± 5.2. The mean change in SAQLI was 0.1 ± 1.0 for the ASV group and 0.1 ± 0.8 for the CPAP group.
Table 2. Characteristics of included studies
|
Study |
Participants |
Comparison |
Follow-up |
Outcome measures |
Comments |
Risk of bias (per outcome measure)* |
|
Individual studies |
||||||
|
Allam, 2007 |
N at baseline:63 Intervention: 58 Control: 47
Age (median, range): 70.7 (58.7–77.5) years
Sex (% female): 14%
BMI (mean, IQR): 31 (29 – 34)
AHI baseline (median, IQR): 30 (15 – 54) |
Intervention: ASV Control: CPAP |
N/A |
AHI |
Patients with congestive heart failure, atrial fibrillation, insomnia, opioid use and CVA were not excluded. PAP interventions with > 60 min of trial time were included for analysis. No clear description of follow-up time, and no distinction which subgroups were contacted. Two authors received equipment and financial support from ResMed Inc. for other protocols, one of them concerning ASV. |
Some concerns (AHI)
|
|
Morgenthaler, 2014 |
N at baseline: 66 Intervention: 33 Control: 33
Age (mean, SD) Intervention: 59.1 ± 14.2 years Control: 59.4 ± 11.7 years
Sex (% male) Intervention: 78.8% Control: 90.9%
BMI (mean, SD) Intervention: 34.8 (7.5) Control: 35.1 (8.5)
AHI baseline (mean, SD) Intervention: 35.1 (+ 25.3) Control: 37.9 (+ 29.3) |
Intervention: ASV Control: CPAP |
90 days |
AHI, quality of life (SAQLI, ESS) |
Patients with stable heart failure, atrial fibrillation, insomnia and chronic opioid use were not excluded. Grant from ResMed Corp, two authors served as a consultant for ResMed Inc. |
Some concerns (AHI) Some concerns (ESS) Some concerns (SAQLI) |
*For further details, see risk of bias table in the appendix
A systematic review of the literature was performed to answer the following question:
What is the effectiveness of Continuous Positive Airway Pressure (CPAP) compared to control treatment (O₂, ASV, conservative treatment) on Apnea-hypopnea index (AHI), Quality of life (QoL) or mortality in patients with (C)PAP-induced TECSA?
Table 1. PICO
|
Patients |
patients with OSA and CPAP induced CSA |
|
Intervention |
change to other treatment (O₂, Adaptive-servoventilatie (ASV), conservative treatment) |
|
Control |
continued (C)PAP treatment |
|
Outcomes |
Apnea-hypopnea index (AHI), Quality of life (QoL), mortality |
|
Other selection criteria |
Study design: systematic reviews, randomized controlled trials, and observational studies
Age range: 18+ |
Relevant outcome measures
The guideline panel considered reduction of AHI as a critical outcome measure for decision making; and improvement of QoL as an important outcome measure for decision making.
The guideline panel defined the following as a minimal clinically (patient) important difference:
- Apnea-hypopnea index (AHI): decrease by 50%;
- Quality of life (QoL): Difference of > 1.0 in the Sleep Apnea Quality of Life Index (SAQLI) score. Difference of ≥ 2 points on the Epworth Sleepiness Scale (ESS).
Search and select (Methods)
A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com and Ovid/Medline. Both databases were searched to the 23rd of April 2025 for systematic reviews (no restriction on time), RCTs and observational studies. Systematic searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from three primary search concepts: (1) complex sleep apnea; (2) treatment emergent central sleep apnea; (3) continuous positive airway pressure. Duplicates were removed using EndNote software. After deduplication a total of 679 records were imported for title/abstract screening.
Initially, 71 studies were selected based on title and abstract screening. After reading the full text, 69 studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and 2 studies were included.
- American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed, tect revision. Darien, IL: American Academy of Sleep Medicine; 2023.
- Allam JS, Olson EJ, Gay PC, Morgenthaler TI. Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes. Chest. 2007 Dec;132(6):1839-46. doi: 10.1378/chest.07-1715. PMID: 18079219.
- Arzt M, Munt O, Pépin JL, Heinzer R, Kübeck R, von Hehn U, Ehrsam-Tosi D, Benjafield A, Woehrle H. Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation (READ-ASV): protocol and cohort profile. ERJ Open Res. 2023 Apr 17;9(2):00618-2022. doi: 10.1183/23120541.00618-2022. PMID: 37077553; PMCID: PMC10107058.
- Badr MS, Khayat RN, Allam JS, Hyer S, Mustafa RA, Naughton MT, Patil S, Pien GW, Randerath W, Won C. Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025 Dec 1;21(12):2181-2191. doi: 10.5664/jcsm.11858. PMID: 40820608; PMCID: PMC12670627.
- Lehman S, Antic NA, Thompson C, Catcheside PG, Mercer J, McEvoy RD. Central sleep apnea on commencement of continuous positive airway pressure in patients with a primary diagnosis of obstructive sleep apnea-hypopnea. J Clin Sleep Med. 2007 Aug 15;3(5):462-6. PMID: 17803008; PMCID: PMC1978327.
- Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, De Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, La Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017 Jan 18;49(1):1600959. doi: 10.1183/13993003.00959-2016. PMID: 27920092.
- Randerath W, Baillieul S, Tamisier R. Central sleep apnoea: not just one phenotype. Eur Respir Rev. 2024 Mar 27;33(171):230141. doi: 10.1183/16000617.0141-2023. PMID: 38537948; PMCID: PMC10966472.
- Randerath WJ, Schiza SE, Arzt M, Bonsignore MR, Heinzer R, Lombardi C, Lyssens R, Parati G, Penzel T, Pepin JL, Pevernagie D, Ryan S, Vignatelli L, Schwarz EI. European Respiratory Society and European Sleep Research Society statement on the treatment of central sleep apnoea with adaptive servo-ventilation. Eur Respir J. 2025 Aug 22;66(2):2500263. doi: 10.1183/13993003.00263-2025. PMID: 40571320.
- Zhu Y, Cong J, Lin L, Du J, Long L, He Y, Ren J. Minimum clinically important differences in the Minnesota Living with Heart Failure questionnaire: from a study of heart failure patients treated with integrated Chinese and Western medicine. Front Cardiovasc Med. 2023 Nov 27;10:1242216. doi: 10.3389/fcvm.2023.1242216. PMID: 38089764; PMCID: PMC10711109.
Risk of Bias tables
|
Author, year |
Selection of participants
Was selection of exposed and non-exposed cohorts drawn from the same population?
|
Exposure
Can we be confident in the assessment of exposure?
|
Outcome of interest
Can we be confident that the outcome of interest was not present at start of study?
|
Confounding-assessment
Can we be confident in the assessment of confounding factors?
|
Confounding-analysis
Did the study match exposed and unexposed for all variables that are associated with the outcome of interest or did the statistical analysis adjust for these confounding variables?
|
Assessment of outcome
Can we be confident in the assessment of outcome?
|
Follow up
Was the follow up of cohorts adequate? In particular, was outcome data complete or imputed?
|
Co-interventions
Were co-interventions similar between groups?
|
Overall Risk of bias
|
|
Allam, 2007 |
Definitely yes;
Reason: Retrospective chart review of first 100 patients. |
Probably yes;
Reason: No clear description of assessment of exposure. |
Definitely no;
Reason: Patients, that were included were already suffering from apnoea |
No information |
No information |
Definitely yes;
Reason: Assessment was well described. |
Definitely no;
Reason: Limited information on follow-up time, and no distinction in which subgroup were contacted. |
Probably yes;
Reason: Co-interventions were probably similar between groups, though clear description of co-interventions lack. |
Some concern (AHI) |
|
Author, year |
Was the allocation sequence adequately generated?
|
Was the allocation adequately concealed?
|
Blinding: Was knowledge of the allocated interventions adequately prevented?
Were patients blinded?
Were healthcare providers blinded?
Were data collectors blinded?
Were outcome assessors blinded?
Were data analysts blinded? |
Was loss to follow-up (missing outcome data) infrequent?
|
Are reports of the study free of selective outcome reporting?
|
Was the study apparently free of other problems that could put it at a risk of bias?
|
Overall risk of bias If applicable/necessary, per outcome measure
|
|
Morgenthaler, 2014 |
Probably yes;
Reason: No clear description of randomization process. |
Probably yes;
Reason: No clear description of randomization process. |
Definitely no
Reason: Single blinded study, researchers were not blinded. |
Probably yes
Reason: Loss to follow-up was infrequent in intervention and control group. |
Definitely yes
Reason: All relevant outcomes were reported. |
Probably no;
Reason: Grant from ResMed Corp, two authors served as a consultant for ResMed Inc. |
Some concerns (AHI) Some concerns (ESS) Some concerns (SAQLI) |
Table of excluded studies
|
Reference |
Reason for exclusion |
|
SRs and RCTs |
|
|
Kuzniar TJ, Patel S, Nierodzik CL, Smith LC. Comparison of two servo ventilator devices in the treatment of complex sleep apnea. Sleep Med. 2011 Jun;12(6):538-41. doi: 10.1016/j.sleep.2010.09.017. Epub 2011 May 14. PMID: 21576036. |
Wrong intervention. Compares two servo-ventilation devices and no CPAP
|
|
Brown SE, Mosko SS, Davis JA, Pierce RA, Godfrey-Pixton TV. A retrospective case series of adaptive servoventilation for complex sleep apnea. J Clin Sleep Med. 2011 Apr 15;7(2):187-95. PMID: 21509335; PMCID: PMC3077348. |
Wrong study design (retrospective case-series) |
|
Dellweg D, Kerl J, Hoehn E, Wenzel M, Koehler D. Randomized controlled trial of noninvasive positive pressure ventilation (NPPV) versus servoventilation in patients with CPAP-induced central sleep apnea (complex sleep apnea). Sleep. 2013 Aug 1;36(8):1163-71. doi: 10.5665/sleep.2878. PMID: 23904676; PMCID: PMC3700713. |
Wrong Intervention. After 6 weeks on CPAP, patients are randomized to receive BiPAP or servo-ventilation.
|
|
Morgenthaler TI, Gay PC, Gordon N, Brown LK. Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes. Sleep. 2007 Apr;30(4):468-75. doi: 10.1093/sleep/30.4.468. PMID: 17520791. |
Wrong intervention (NVVP not specified)
|
|
Nigam G, Riaz M, Chang ET, Camacho M. Natural history of treatment-emergent central sleep apnea on positive airway pressure: A systematic review. Ann Thorac Med. 2018 Apr-Jun;13(2):86-91. doi: 10.4103/atm.ATM_321_17. PMID: 29675059; PMCID: PMC5892094. |
Wrong intervention/comparison
|
|
Javaheri S, Goetting MG, Khayat R, Wylie PE, Goodwin JL, Parthasarathy S. The performance of two automatic servo-ventilation devices in the treatment of central sleep apnea. Sleep. 2011 Dec 1;34(12):1693-8. doi: 10.5665/sleep.1438. PMID: 22131607; PMCID: PMC3208847. |
Wrong intervention/comparison (two servo ventilation techniques)
|
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Krakow B, McIver ND, Ulibarri VA, Krakow J, Schrader RM. Prospective Randomized Controlled Trial on the Efficacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia. EClinicalMedicine. 2019 Aug 8;13:57-73. doi: 10.1016/j.eclinm.2019.06.011. PMID: 31517263; PMCID: PMC6734001. |
Wrong population (OSA)
|
|
Chen C, Wen T, Liao W. Nocturnal supports for patients with central sleep apnea and heart failure: a systemic review and network meta-analysis of randomized controlled trials. Ann Transl Med. 2019 Jul;7(14):337. doi: 10.21037/atm.2019.06.72. PMID: 31475207; PMCID: PMC6694234. |
Wrong population (not CSA specific, with heart failure)
|
|
Nigam G, Pathak C, Riaz M. A systematic review on prevalence and risk factors associated with treatment- emergent central sleep apnea. Ann Thorac Med. 2016 Jul-Sep;11(3):202-10. doi: 10.4103/1817-1737.185761. PMID: 27512510; PMCID: PMC4966223. |
Wrong outcome (prevalence of TESCA, not comparison between intervention and comparator)
|
|
Heider K, Arzt M, Lerzer C, Kolb L, Pfeifer M, Maier LS, Gfüllner F, Malfertheiner MV. Adaptive servo-ventilation and sleep quality in treatment emergent central sleep apnea and central sleep apnea in patients with heart disease and preserved ejection fraction. Clin Res Cardiol. 2018 May;107(5):421-429. doi: 10.1007/s00392-018-1203-9. Epub 2018 Jan 25. PMID: 29372314. |
Wrong comparison (TESCA vs CSA)
|
|
Yao SM, Zhang XL. [Association between residual sleepiness and central sleep apnea events in patients with obstructive sleep apnea syndrome]. Zhonghua Jie He He Hu Xi Za Zhi. 2008 Sep;31(9):664-9. Chinese. PMID: 19080566. |
Wrong population, wrong outcome (residual sleepiness), only available in Chinese
|
|
Westhoff M, Arzt M, Litterst P. Prevalence and treatment of central sleep apnoea emerging after initiation of continuous positive airway pressure in patients with obstructive sleep apnoea without evidence of heart failure. Sleep Breath. 2012 Mar;16(1):71-8. doi: 10.1007/s11325-011-0486-0. Epub 2011 Feb 25. PMID: 21347650. |
Wrong outcome (prevalence of CompSAS/CSA)
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|
Cassel W, Canisius S, Becker HF, Leistner S, Ploch T, Jerrentrup A, Vogelmeier C, Koehler U, Heitmann J. A prospective polysomnographic study on the evolution of complex sleep apnoea. Eur Respir J. 2011 Aug;38(2):329-37. doi: 10.1183/09031936.00162009. Epub 2011 Apr 4. PMID: 21464115. |
Wrong outcome (prevalence of CompSAS)
|
|
Kuźniar TJ, Kasibowska-Kuźniar K, Ray DW, Freedom T. Clinical heterogeneity of patients with complex sleep apnea syndrome. Sleep Breath. 2013 Dec;17(4):1209-14. doi: 10.1007/s11325-013-0825-4. Epub 2013 Feb 23. PMID: 23436008; PMCID: PMC3898341. |
Wrong population, wrong outcome (prevalence of risk factors)
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|
Nakazaki C, Noda A, Yasuda Y, Nakata S, Koike Y, Yasuma F, Murohara T, Nakashima T. Continuous positive airway pressure intolerance associated with elevated nasal resistance is possible mechanism of complex sleep apnea syndrome. Sleep Breath. 2012 Sep;16(3):747-52. doi: 10.1007/s11325-011-0570-5. Epub 2011 Aug 10. PMID: 21830062. |
Wrong population, wrong outcome (pathophysiology)
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Mulgrew AT, Lawati NA, Ayas NT, Fox N, Hamilton P, Cortes L, Ryan CF. Residual sleep apnea on polysomnography after 3 months of CPAP therapy: clinical implications, predictors and patterns. Sleep Med. 2010 Feb;11(2):119-25. doi: 10.1016/j.sleep.2009.05.017. Epub 2010 Jan 18. PMID: 20083429. |
Wrong population, wrong outcome (predictors)
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|
Vuong RQ, Packard A. Treatment-emergent central sleep apnea (TECSA) with chronic use of mandibular advancement device (MAD): a case series. Sleep Vigil. 2024;8:337–42. doi:10.1007/s41782-024-00272-9. |
Wrong intervention, wrong study design |
|
Berger M, Solelhac G, Horvath C, Heinzer R, Brill AK. Treatment-emergent central sleep apnea associated with non-positive airway pressure therapies in obstructive sleep apnea patients: A systematic review. Sleep Med Rev. 2021 Aug;58:101513. doi: 10.1016/j.smrv.2021.101513. Epub 2021 Jun 5. PMID: 34166994. |
Wrong intervention/comparison, wrong outcome (prevalence)
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Zhang J, Wang L, Guo HJ, Wang Y, Cao J, Chen BY. Treatment-emergent central sleep apnea: a unique sleep-disordered breathing. Chin Med J (Engl). 2020 Nov 20;133(22):2721-2730. doi: 10.1097/CM9.0000000000001125. PMID: 33009018; PMCID: PMC7725531. |
Wrong outcome (prevalence); non-systematic review (one database)
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Cantero C, Adler D, Pasquina P, Uldry C, Egger B, Prella M, Younossian AB, Poncet A, Soccal-Gasche P, Pepin JL, Janssens JP. Adaptive Servo-Ventilation: A Comprehensive Descriptive Study in the Geneva Lake Area. Front Med (Lausanne). 2020 Apr 3;7:105. doi: 10.3389/fmed.2020.00105. PMID: 32309284; PMCID: PMC7145945. |
Wrong comparison (indications of use of ASV)
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Galetke W, Ghassemi BM, Priegnitz C, Stieglitz S, Anduleit N, Richter K, Randerath WJ. Anticyclic modulated ventilation versus continuous positive airway pressure in patients with coexisting obstructive sleep apnea and Cheyne-Stokes respiration: a randomized crossover trial. Sleep Med. 2014 Aug;15(8):874-9. doi: 10.1016/j.sleep.2014.02.012. Epub 2014 Apr 18. PMID: 24841107. |
Wrong population (OSA, CSR), wrong comparison (ACMV vs CPAP)
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Tamisier R, Philippe C, Prigent A, Charley-Monaca C, d'Ortho MP, Gentina T, Gagnadoux F, Launois C, Bironneau V, Mallet JP, Didi T, Guy T, Goutorbe F, Perrin C, Pontier-Marchandise S, Timsit JF, Pépin JL, Meurice JC; Etude de Cohorte Observationnelle Multicentrique Française de Patients Ayant un Syndrome d’Apnées du Sommeil Central ou Combiné Avec SAS Central Prédominant, Traités par Ventilation Auto-asservie Investigators. Change in Sleep Quality Associated With Adaptive Servoventilation for Central Sleep Apnea: Six-Month Follow-Up of the Multicenter Nationwide French "Etude de Cohorte Observationnelle Multicentrique Française de Patients Ayant un Syndrome d'Apnées du Sommeil Central ou Combiné Avec SAS Central Prédominant, Traités par Ventilation Auto-Asservie (FACIL-VAA)" Cohort. Chest. 2025 Apr;167(4):1204-1217. doi: 10.1016/j.chest.2024.12.015. Epub 2024 Dec 20. PMID: 39710250. |
Wrong outcome (PSQI)
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Krakow BJ, McIver ND, Obando JJ, Ulibarri VA. Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea: a retrospective, nonrandomized controlled study. Mil Med Res. 2019 May 9;6(1):15. doi: 10.1186/s40779-019-0204-y. PMID: 31072385; PMCID: PMC6507057. |
Wrong population (PTSD with OSA), wrong comparison, wrong outcome (ISI)
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Naito R, Kasai T, Tomita Y, Kasagi S, Narui K, Momomura SI. Clinical outcomes of chronic heart failure patients with unsuppressed sleep apnea by positive airway pressure therapy. Front Cardiovasc Med. 2023 Jun 16;10:1156353. doi: 10.3389/fcvm.2023.1156353. PMID: 37396594; PMCID: PMC10313110. |
Wrong population (heart failure), wrong outcome (all-cause death/hospitalization)
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Krachman SL, D'Alonzo GE, Berger TJ, Eisen HJ. Comparison of oxygen therapy with nasal continuous positive airway pressure on Cheyne-Stokes respiration during sleep in congestive heart failure. Chest. 1999 Dec;116(6):1550-7. doi: 10.1378/chest.116.6.1550. PMID: 10593775. |
Wrong population (heart failure), wrong comparison
|
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Hu K, Yang J, Chen XQ, Yu CP, Zhao JL. [Comparison of oxygen therapy with nasal continuous positive airway pressure on Cheyne-Stokes respiration in patients with chronic congestive heart failure]. Zhonghua Nei Ke Za Zhi. 2005 Oct;44(10):759-63. Chinese. PMID: 16255886. |
Wrong population (congenital heart failure), wrong comparison, only available in Chinese
|
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Bradley TD, Logan AG, Kimoff RJ, Sériès F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Tomlinson G, Floras JS; CANPAP Investigators. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005 Nov 10;353(19):2025-33. doi: 10.1056/NEJMoa051001. PMID: 16282177. |
Wrong population (heart failure and CSA), wrong outcomes
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Ushijima R, Joho S, Akabane T, Oda Y, Inoue H. Differing effects of adaptive servoventilation and continuous positive airway pressure on muscle sympathetic nerve activity in patients with heart failure. Circ J. 2014;78(6):1387-95. doi: 10.1253/circj.cj-13-1468. Epub 2014 Apr 4. PMID: 24705391. |
Wrong population (heart failure and periodic breathing), wrong outcome (MSNA)
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Thomas RJ, Daly RW, Weiss JW. Low-concentration carbon dioxide is an effective adjunct to positive airway pressure in the treatment of refractory mixed central and obstructive sleep-disordered breathing. Sleep. 2005 Jan;28(1):69-77. doi: 10.1093/sleep/28.1.69. PMID: 15700722. |
Wrong intervention (added carbon dioxide)
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Marrone O, Stallone A, Salvaggio A, Milone F, Bellia V, Bonsignore G. Occurrence of breathing disorders during CPAP administration in obstructive sleep apnoea syndrome. Eur Respir J. 1991 Jun;4(6):660-6. PMID: 1889492. |
Wrong comparison, wrong outcome (breathing patterns)
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|
Zeineddine S, Rowley JA, Chowdhuri S. Oxygen Therapy in Sleep-Disordered Breathing. Chest. 2021 Aug;160(2):701-717. doi: 10.1016/j.chest.2021.02.017. Epub 2021 Feb 19. PMID: 33610579. |
Wrong population (SB), wrong intervention (NSO), wrong outcome
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Jaffuel D, Rabec C, Philippe C, Mallet JP, Georges M, Redolfi S, Palot A, Suehs CM, Nogue E, Molinari N, Bourdin A. Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume! : Adaptive servo-ventilation settings in real-life conditions. Respir Res. 2020 Sep 21;21(1):243. doi: 10.1186/s12931-020-01509-7. PMID: 32957983; PMCID: PMC7507637. |
Wrong comparison, wrong outcome
|
|
Saito K, Takamatsu Y. Periodic breathing in patients with stable obstructive sleep apnea on long-term continuous positive airway pressure treatment: a retrospective study using CPAP remote monitoring data. Sleep Breath. 2022 Sep;26(3):1181-1191. doi: 10.1007/s11325-021-02510-0. Epub 2021 Oct 14. PMID: 34651259; PMCID: PMC9418282. |
Wrong outcome (periodic breathing rate)
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Ni YN, Thomas RJ. Predictors and consequences of residual apnea during positive airway pressure therapy. Sleep Med. 2023 Jun;106:42-51. doi: 10.1016/j.sleep.2023.03.027. Epub 2023 Mar 28. PMID: 37044000. |
Wrong comparison, wrong outcome (risk factors/consequences)
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Farghaly S, Thabet A. Role of continuous positive airway pressure in patients with combined sleep apnea syndrome without congestive heart failure. Egypt J Chest Dis Tuberc. 2016;65(3):673–679. doi:10.1016/j.ejcdt.2016.03.006 |
Wrong population (combined group), wrong comparison (no comparison between interventions)
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Ryan CM, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson KA, Belenkie I, Pfeifer M, Fleetham J, Hanly PJ, Smilovitch M, Arzt M, Bradley TD; CANPAP Investigators. Shift in sleep apnoea type in heart failure patients in the CANPAP trial. Eur Respir J. 2010 Mar;35(3):592-7. doi: 10.1183/09031936.00070509. PMID: 20190331. |
Wrong population (HF), wrong comparison (CSA vs OSA), wrong outcome (LVEF)
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Dernaika T, Tawk M, Nazir S, Younis W, Kinasewitz GT. The significance and outcome of continuous positive airway pressure-related central sleep apnea during split-night sleep studies. Chest. 2007 Jul;132(1):81-7. doi: 10.1378/chest.06-2562. Epub 2007 May 2. PMID: 17475636. |
Wrong population (OSA), wrong comparison, wrong outcome
|
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Vazir A, Hastings PC, Papaioannou I, Poole-Wilson PA, Cowie MR, Morrell MJ, Simonds AK. Variation in severity and type of sleep-disordered breathing throughout 4 nights in patients with heart failure. Respir Med. 2008 Jun;102(6):831-9. doi: 10.1016/j.rmed.2008.01.015. Epub 2008 Mar 17. PMID: 18343647. |
Wrong population (CHF with OSA), wrong comparison (OSA vs. CSA), wrong outcome (severity/type of SDB)
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Malfertheiner MV, Lerzer C, Kolb L, Heider K, Zeman F, Gfüllner F, Maier LS, Pfeifer M, Arzt M. Whom are we treating with adaptive servo-ventilation? A clinical post hoc analysis. Clin Res Cardiol. 2017 Sep;106(9):702-710. doi: 10.1007/s00392-017-1112-3. Epub 2017 Apr 17. PMID: 28417254. |
Wrong population (CHF), wrong outcome (type of SDB, breathing pattern, LVEF)
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Han YC, Shen ZJ, Zhang SY, Gao P, Xiang RL, Qian H, Xie HZ. Efficacy of adaptive servo-ventilation and continuous positive airway pressure treatment in chronic heart failure with sleep-disordered breathing: a systematic review and meta-analysis. Heart Fail Rev. 2021 May;26(3):521-529. doi: 10.1007/s10741-020-10050-0. Epub 2021 Jan 14. PMID: 33443725. |
Wrong population (HFrEF + SDB)
|
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Bordier P, Lataste A, Hofmann P, Robert F, Bourenane G. Nocturnal oxygen therapy in patients with chronic heart failure and sleep apnea: a systematic review. Sleep Med. 2016 Jan;17:149-57. doi: 10.1016/j.sleep.2015.10.017. Epub 2015 Dec 2. PMID: 26847991. |
Wrong population (CHF), wrong intervention (NOT)
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Randerath WJ, Galetke W, Stieglitz S, Laumanns C, Schäfer T. Adaptive servo-ventilation in patients with coexisting obstructive sleep apnoea/hypopnoea and Cheyne-Stokes respiration. Sleep Med. 2008 Dec;9(8):823-30. doi: 10.1016/j.sleep.2008.02.011. Epub 2008 Jul 21. PMID: 18640873. |
Wrong intervention (BiPAP AutoSV), wrong comparison
|
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Javaheri S, Harris N, Howard J, Chung E. Adaptive servoventilation for treatment of opioid-associated central sleep apnea. J Clin Sleep Med. 2014 Jun 15;10(6):637-43. doi: 10.5664/jcsm.3788. PMID: 24932143; PMCID: PMC4031404. |
Wrong population (opiod users, no TESCA)
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Verbraecken J. Clinical implications of residual sleep apnoea after chronic CPAP therapy. Breathe (Sheff). 2011;7(3):289–290. doi:10.1183/20734735.022010 |
Wrong population (residual SA), wrong outcome (prevalence)
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Randerath WJ, Galetke W, Kenter M, Richter K, Schäfer T. Combined adaptive servo-ventilation and automatic positive airway pressure (anticyclic modulated ventilation) in co-existing obstructive and central sleep apnea syndrome and periodic breathing. Sleep Med. 2009 Sep;10(8):898-903. doi: 10.1016/j.sleep.2008.09.017. Epub 2009 Mar 20. PMID: 19303811. |
Wrong intervention (AMCV)
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Krawczyk M, Flinta I, Garncarek M, Jankowska EA, Banasiak W, Germany R, Javaheri S, Ponikowski P. Sleep disordered breathing in patients with heart failure. Cardiol J. 2013;20(4):345-55. doi: 10.5603/CJ.2013.0092. PMID: 23913452. |
Wrong population (SDB)
|
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Kuźniar TJ, Morgenthaler TI. Treatment of complex sleep apnea syndrome. Curr Treat Options Neurol. 2008 Sep;10(5):336-41. doi: 10.1007/s11940-008-0036-7. PMID: 18782506. |
Wrong comparison
|
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Kuzniar TJ, Patel S, Nierodzik CL, Smith LC. Comparison of two servo ventilator devices in the treatment of complex sleep apnea. Sleep Med. 2011 Jun;12(6):538-41. doi: 10.1016/j.sleep.2010.09.017. Epub 2011 May 14. PMID: 21576036. |
Wrong comparison |
|
Brown SE, Mosko SS, Davis JA, Pierce RA, Godfrey-Pixton TV. A retrospective case series of adaptive servoventilation for complex sleep apnea. J Clin Sleep Med. 2011 Apr 15;7(2):187-95. PMID: 21509335; PMCID: PMC3077348. |
No differentiation between CSA subtypes |
|
Dellweg D, Kerl J, Hoehn E, Wenzel M, Koehler D. Randomized controlled trial of noninvasive positive pressure ventilation (NPPV) versus servoventilation in patients with CPAP-induced central sleep apnea (complex sleep apnea). Sleep. 2013 Aug 1;36(8):1163-71. doi: 10.5665/sleep.2878. PMID: 23904676; PMCID: PMC3700713. |
Wrong comparison, NPPV versus ASV
|
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Morgenthaler TI, Gay PC, Gordon N, Brown LK. Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes. Sleep. 2007 Apr;30(4):468-75. doi: 10.1093/sleep/30.4.468. PMID: 17520791. |
Wrong comparison, NPPV versus ASV
|
|
Heider K, Arzt M, Lerzer C, Kolb L, Pfeifer M, Maier LS, Gfüllner F, Malfertheiner MV. Adaptive servo-ventilation and sleep quality in treatment emergent central sleep apnea and central sleep apnea in patients with heart disease and preserved ejection fraction. Clin Res Cardiol. 2018 May;107(5):421-429. doi: 10.1007/s00392-018-1203-9. Epub 2018 Jan 25. PMID: 29372314. |
Wrong population, specifically patients with structural heart disease |
|
Yao SM, Zhang XL. [Association between residual sleepiness and central sleep apnea events in patients with obstructive sleep apnea syndrome]. Zhonghua Jie He He Hu Xi Za Zhi. 2008 Sep;31(9):664-9. Chinese. PMID: 19080566. |
Full text only available in Chinese |
|
Westhoff M, Arzt M, Litterst P. Prevalence and treatment of central sleep apnoea emerging after initiation of continuous positive airway pressure in patients with obstructive sleep apnoea without evidence of heart failure. Sleep Breath. 2012 Mar;16(1):71-8. doi: 10.1007/s11325-011-0486-0. Epub 2011 Feb 25. PMID: 21347650. |
Wrong comparison, not between CPAP and ASV |
|
Kuźniar TJ, Kasibowska-Kuźniar K, Ray DW, Freedom T. Clinical heterogeneity of patients with complex sleep apnea syndrome. Sleep Breath. 2013 Dec;17(4):1209-14. doi: 10.1007/s11325-013-0825-4. Epub 2013 Feb 23. PMID: 23436008; PMCID: PMC3898341. |
Wrong comparison, not between CPAP and ASV |
|
Observational studies |
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Gupta A, Shukla G. Polysomnographic determinants of requirement for advanced positive pressure therapeutic options for obstructive sleep apnea. Sleep Breath. 2018 May;22(2):401-409. doi: 10.1007/s11325-017-1556-8. Epub 2017 Aug 18. PMID: 28822020. |
Wrong population (OSA), wrong outcome (determinants of poor repsonse to CPAP)
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Carrera MB, Gómez García MT, Troncoso M, Salas R, González-Mangado N. Características clínicas y polisomnográficas de pacientes con apnea central. ¿Se benefician de servoventilación adaptativa? Rev Patol Respir. 2013;16(1):42–50. |
Only available in Spanish |
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Noah WH, Messineo L, Hete B, Thompson E, White DP, Farney RJ, Sundar KM. Treatment-emergent central sleep apnea resolves with lower inspiratory pressure. J Clin Sleep Med. 2025 Mar 1;21(3):559-564. doi: 10.5664/jcsm.11492. PMID: 39655462; PMCID: PMC11874087. |
Wrong intervention (addition of V-COM IPAP)
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Su M, Zhang X, Huang M, Ding N. Adaptive pressure support servoventilation: a novel treatment for residual sleepiness associated with central sleep apnea events. Sleep Breath. 2011 Dec;15(4):695-9. doi: 10.1007/s11325-010-0424-6. Epub 2010 Sep 23. PMID: 20862555. |
Wrong population (OSAS), wrong outcome (residual sleepiness)
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Javaheri S, Malik A, Smith J, Chung E. Adaptive pressure support servoventilation: a novel treatment for sleep apnea associated with use of opioids. J Clin Sleep Med. 2008 Aug 15;4(4):305-10. PMID: 18763420; PMCID: PMC2542500. |
Wrong population (opioid induced sleep apnea)
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Ramar K, Ramar P, Morgenthaler TI. Adaptive servoventilation in patients with central or complex sleep apnea related to chronic opioid use and congestive heart failure. J Clin Sleep Med. 2012 Oct 15;8(5):569-76. doi: 10.5664/jcsm.2160. PMID: 23066370; PMCID: PMC3459204. |
Wrong population (CHF and opioid induced sleep apnea)
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Stanchina M, Robinson K, Corrao W, Donat W, Sands S, Malhotra A. Clinical Use of Loop Gain Measures to Determine Continuous Positive Airway Pressure Efficacy in Patients with Complex Sleep Apnea. A Pilot Study. Ann Am Thorac Soc. 2015 Sep;12(9):1351-7. doi: 10.1513/AnnalsATS.201410-469BC. PMID: 26214564; PMCID: PMC5467091. |
Wrong intervention (loop gain)
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Patel J, Daniels K, Bogdan L, Huntley C, Boon M. Elevated Central and Mixed Apnea Index after Upper Airway Stimulation. Otolaryngol Head Neck Surg. 2020 May;162(5):767-772. doi: 10.1177/0194599820912740. Epub 2020 Mar 17. PMID: 32178573. |
Wrong intervention (UAS), wrong outcome (CMAI), wrong study design (retrospective chart review)
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Goodday RH, Fay MB. Emergence of Central Sleep Apnea Events After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea. J Oral Maxillofac Surg. 2019 Nov;77(11):2303-2307. doi: 10.1016/j.joms.2019.06.002. Epub 2019 Jun 19. PMID: 31302064. |
Wrong population (maxillomandibular advancement surgery)
|
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Wang Y, Penzel T, Salanitro M, Arens P. Persistent Treatment-Emergent Central Sleep Apnea (TECSA) Following Hypoglossal Nerve Stimulation. Nat Sci Sleep. 2022 Dec 22;14:2227-2236. doi: 10.2147/NSS.S382710. PMID: 36578670; PMCID: PMC9791954. |
Wrong population (HNS-induced TECSA)
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Hellemans S, Van de Perck E, Braem MJ, Verbraecken J, Dieltjens M, Vanderveken OM. The prevalence of treatment-emergent central sleep apnea with mandibular advancement device therapy. J Clin Sleep Med. 2023 Dec 1;19(12):2035-2041. doi: 10.5664/jcsm.10742. PMID: 37539639; PMCID: PMC10692941. |
Wrong population (mandibular advancement devices)
|
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Aïssani H, Kün-Darbois JD, Moreau C, Gagnadoux F, Trzepizur W; IRSR Pays de la Loire Sleep Cohort Study Group. Treatment-emergent central sleep apnea in patients treated with a mandibular advancement device. Sleep Med. 2025 Mar;127:81-88. doi: 10.1016/j.sleep.2025.01.010. Epub 2025 Jan 13. PMID: 39824036. |
Wrong population (mandibular advancement devices)
|
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Kuźniar TJ, Kasibowska-Kuźniar K, Freedom T. Trials of bilevel positive airway pressure - spontaneous in patients with complex sleep apnoea. Pneumonol Alergol Pol. 2012;80(3):214-9. PMID: 22562273. |
Wrong comparison (BPAP-s versus CPAP)
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Montesi SB, Bakker JP, Macdonald M, Hueser L, Pittman S, White DP, Malhotra A. Air leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med. 2013 Nov 15;9(11):1187-91. doi: 10.5664/jcsm.3166. PMID: 24235901; PMCID: PMC3805805. |
Wrong outcome (air leak between two groups)
|
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Moro M, Gannon K, Lovell K, Merlino M, Mojica J, Bianchi MT. Clinical predictors of central sleep apnea evoked by positive airway pressure titration. Nat Sci Sleep. 2016 Jul 27;8:259-66. doi: 10.2147/NSS.S110032. PMID: 27555802; PMCID: PMC4968988. |
Wrong outcome (predictors of TECSA development)
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Kuzniar TJ, Pusalavidyasagar S, Gay PC, Morgenthaler TI. Natural course of complex sleep apnea--a retrospective study. Sleep Breath. 2008 May;12(2):135-9. doi: 10.1007/s11325-007-0140-z. PMID: 17874254. |
Wrong outcome (persistance of CompSAS)
|
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Liu D, Armitstead J, Benjafield A, Shao S, Malhotra A, Cistulli PA, Pepin JL, Woehrle H. Trajectories of Emergent Central Sleep Apnea During CPAP Therapy. Chest. 2017 Oct;152(4):751-760. doi: 10.1016/j.chest.2017.06.010. Epub 2017 Jun 16. PMID: 28629918; PMCID: PMC6026232. |
Wrong outcome (CSA trajectories)
|
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Correia S, Martins V, Sousa L, Moita J, Teixeira F, Dos Santos JM. Clinical impact of adaptive servoventilation compared to other ventilatory modes in patients with treatment-emergent sleep apnea, central sleep apnea and Cheyne-Stokes respiration. Rev Port Pneumol (2006). 2015 May-Jun;21(3):132-7. doi: 10.1016/j.rppnen.2014.08.005. Epub 2015 Mar 9. PMID: 25926251. |
No differentiation in CSA subtypes |
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Pépin JL, Woehrle H, Liu D, Shao S, Armitstead JP, Cistulli PA, Benjafield AV, Malhotra A. Adherence to Positive Airway Therapy After Switching From CPAP to ASV: A Big Data Analysis. J Clin Sleep Med. 2018 Jan 15;14(1):57-63. doi: 10.5664/jcsm.6880. PMID: 29198291; PMCID: PMC5734894. |
No information about diagnosis, no differentiation in CSA subtypes |
|
Su M, Zhang X, Huang M, Ding N. Adaptive pressure support servoventilation: a novel treatment for residual sleepiness associated with central sleep apnea events. Sleep Breath. 2011 Dec;15(4):695-9. doi: 10.1007/s11325-010-0424-6. Epub 2010 Sep 23. PMID: 20862555. |
Wrong population, not specific for TECSA |
|
Kuźniar TJ, Kasibowska-Kuźniar K, Freedom T. Trials of bilevel positive airway pressure - spontaneous in patients with complex sleep apnoea. Pneumonol Alergol Pol. 2012;80(3):214-9. PMID: 22562273. |
Wrong population, not specific for TECSA |
Beoordelingsdatum en geldigheid
Publicatiedatum : 03-11-2026
Beoordeeld op geldigheid : 03-11-2026
Samenstelling werkgroep
Werkgroep
- Dhr. dr. M. (Manuel) Sastry, voorzitter, longarts, Nederlands Slaapinstituut Nederland, NVALT
- Dhr. J. (Jerryll) Asin, vicevoorzitter, longarts, Amphia ziekenhuis, NVALT
- Mevr. dr. H.C.J.P. (Hennie) Janssen, longarts, Centrum voor Slaapgeneeskunde (CSG) Kempenhaeghe, NVALT
- Dhr. W.J.B. (Wouter) Blox, longarts, Albert Schweitzer ziekenhuis, NVALT
- Dhr. prof. dr. P.J. (Peter) Wijkstra, longarts, UMCG, NVALT
- Mevr. E.W. (Esther) Gieteling, neuroloog, SEIN, NVN
- Dhr. prof. dr. D. (Dominik) Linz, cardioloog, MUMC, NVVC
- Dhr. K.E. (Karel) Schreuder, patiëntenvertegenwoordiger, Apneuvereniging
Klankbordgroep
- Dhr. dr. J.M.J.A.A. (Jos) Straetmans, KNO-arts, Zuyderland, NVKNO
- Dhr. N.E. (Nils) van ’t Veer, ziekenhuisapotheker, Amphia, NVZA
Met ondersteuning van
- Dr. A.N. (Nynke) Kampstra, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- Dr. L.K. (Leanne) Küpers, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- Mevr. Fieke Pepping, junior adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- Mevr. Joline Rohof, junior adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- Mevr. E. (Esther) van der Bijl, medisch informatiespecialist, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
Een overzicht van de belangen van de clusterleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.
Werkgroepleden
Tabel 1 Gemelde (neven)functies en belangen stuurgroep
|
Naam |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke financiële belangen |
Persoonlijke relaties |
Extern gefinancierd onderzoek |
Overige belangen |
Restrictie |
|
Manuel Sastry (vz.) |
Sinds 1-6-2024 ZZP longarts bij het Nederlands Slaap Instituut. Voorheen tot 30-11-2024 longarts Academisch Slaapcentrum Ciro en longarts in 0-aanstelling MUMC+, afdeling longziekten. |
De centra voor thuisbeademing (CTB) hebben aangegeven in hun richtlijn “Chronische beademing” (chronische beademing (2021) dat zij de zorg voor volwassenen patiënten met OSA als ook CSA willen overdragen aan daarvoor gekwalificeerde slaapcentra. De CTB en de NVALT Sectie Ademhalingsstoornissen tijdens de Slaap (SAS) hebben daartoe eind 2024 een gezamenlijk visiedocument opgesteld dat door de Nederlandse Vereniging voor Keel-Neus-Oorheelkunde van het Hoofd-Halsgebied (NvKNO), de Nederlandse Vereniging voor Neurologie (NVN) en de Apneuvereniging geaccordeerd is. Ik heb deelgenomen aan de gezamenlijke werkgroep van de CTB en SAS. Wetenschappelijke secretaris NVALT Sectie Ademhalingsstoornissen tijdens de Slaap (SAS) |
Bij mijn werkzaamheden als longarts in een slaapcentrum/ slaapinstituut behandel ik onder andere patiënten met centrale slaapapneu. Uitkomsten van de richtlijn leveren me geen financieel voordeel op. |
Geen |
Tot 30-11-2024 bij De Maastricht Studie (DMS) was ik voor de afdeling longziekten MUMC+ co-eigenaar van longziekten-/slaap- gegevens. DMS heeft 20 partners. Naast het MUMC+, de provincie Limburg en de gemeente Maastricht, zijn dit onder andere meerdere industrie en farmaceutische bedrijven. Meerdere groepen van andere afdelingen hebben gebruik gemaakt van data van de afdeling longziekten. Bij de betreffende publicaties was ik meermaals coauteur geweest, nooit eerste of laatste auteur. Geen van de publicaties had centrale slaapapneu als onderwerp. |
Geen |
Geen |
|
Jerryll Asin
|
Longarts, Amphia Breda |
Voormalig bestuurslid SAS NVALT |
Consultant: ondersteuning ReST-studie als PI bij opzetten twee andere studie/sites elders in Nederland |
Nee |
ReST-studie |
Geen |
Restricties op besluitvorming over N. Phrenicus stimulatie. |
|
Esther Gieteling |
Neuroloog, SEIN |
Werkgroep Slaap Waakstoornissen NVN (onbetaald) |
Geen |
Mijn echtgenoot is longarts met aandachtsgebied longoncologie (geen belangen bij deze richtlijn) |
Zie hieronder: |
Geen |
Geen |
|
Hennie Janssen |
Longarts/somnoloog, |
Voordracht gericht op educatie op een symposium georganiseerd door VIVISOL |
Geen |
Nee |
Deelname aan wetenschappelijk onderzoek binnen the |
Geen |
Geen |
|
Peter Wijkstra |
Longarts, UMCG |
Penning meester European Respiratory Society ( ERS), betaald |
Neen |
Neen |
RESMED - RECAPTURE , chronische beademing bij COPD - Projectleider |
Geen |
Geen |
|
Wouter Blox |
Longarts, Albert Schweitzer ziekenhuis |
Luscii Medical board (adviserende functie, onbezoldigd) |
Geen |
Geen |
Geen |
Geen |
Geen |
|
Dominik Linz |
Cardioloog, Maastricht University Medical Center (MUMC+) |
Geen |
Geen |
Geen |
Geen |
Geen |
Geen |
Betrokken klankbordgroepleden
Tabel 2 Gemelde (neven)functies en belangen expertisegroep
|
Naam |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke financiële belangen |
Persoonlijke relaties |
Extern gefinancierd onderzoek |
Overige belangen |
Restrictie |
|
Jos Straetmans |
KNO-arts, vrijgevestigd, Zuyderland MC Sittard-Heerlen |
Medisch manager RVE Oncologie, Zuyderland MC Sittard-Heerlen |
Niet van toepassing |
Niet van toepassing |
Niet van toepassing |
Niet van toepassing |
Geen |
|
Nils van 't Veer |
Ziekenhuisapotheker, Amphia ziekenhuis |
Geen |
Geen |
Geen |
Geen |
Geen |
Geen |
Inbreng patiëntenperspectief
Het patiëntenperspectief is ingebracht door deelname van de Apneuvereniging aan het cluster.
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerden de clusterleden conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
|
Module |
Uitkomst raming |
Toelichting |
|
Module Acetazolamide bij CSA |
Geen substantiële financiële gevolgen. |
Hoewel uit de toetsing volgt dat de aanbeveling(en) breed toepasbaar zijn (5.000-40.000 patiënten), volgt ook uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft. Er worden daarom geen substantiële financiële gevolgen verwacht. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.
Zoekverantwoording
Zoekstrategie Embase.com 23 april 2025
|
No. |
Query |
Results |
|
#1 |
'central sleep apnea syndrome'/exp OR 'cheyne stokes breathing'/exp OR 'central hypoventilation syndrome'/exp OR 'complex sleep apnea'/exp OR ((csa NEAR/3 (central* OR sleep* OR apn*)):ti,ab,kw) OR ((periodic* NEAR/3 (breathing* OR respiration*)):ti,ab,kw) OR ((central NEAR/3 alveolar NEAR/3 hypoventilat*):ti,ab,kw) OR ((central NEAR/3 hypoventilat* NEAR/3 syndrome*):ti,ab,kw) OR ((ondine* NEAR/3 (syndrome OR curse)):ti,ab,kw) OR (((central* OR complex OR mixed) NEAR/3 sleep* NEAR/3 apn*):ti,ab,kw) OR (((central* OR complex OR mixed) NEAR/3 apn*):ti,ab,kw) OR (((central OR complex OR mixed) NEAR/3 sleep* NEAR/3 disorder* NEAR/3 breath*):ti,ab,kw) OR 'cheyn* stoke*':ti,ab,kw |
12180 |
|
#2 |
'continuous positive airway pressure'/exp OR (((constant* OR continuous* OR continous*) NEAR/3 (airway* OR positive*) NEAR/3 (pressure OR ventilation)):ti,ab,kw) OR cpap:ti,ab,kw OR cppb:ti,ab,kw OR cppv:ti,ab,kw OR ncpap:ti,ab,kw |
38410 |
|
#3 |
'treatment emergent central sleep apnea'/exp OR 'treatment emergent central sleep apn*':ti,ab,kw OR 'treatmentemergent central sleep apn*':ti,ab,kw OR 'tecsa':ti,ab,kw OR 'te csa':ti,ab,kw |
107 |
|
#4 |
#1 AND #2 OR #3 |
1851 |
|
#5 |
#4 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) |
1065 |
|
#6 |
'meta analysis'/exp OR 'systematic review'/exp OR 'scoping review'/exp OR 'rapid review'/exp OR 'umbrella review'/exp OR 'cochrane database of systematic reviews'/jt OR 'network meta-analysis'/exp OR 'networkmeta analy*':ti,ab,kw OR 'networkmetaanaly*':ti,ab,kw OR metaanaly*:ti,ab,kw OR 'meta analy*':ti,ab,kw OR metanaly*:ti,ab,kw OR prisma:ti,ab,kw OR prospero:ti,ab,kw OR metaanali*:ti,ab,kw OR 'meta anali*':ti,ab,kw OR metanali*:ti,ab,kw OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab,kw) OR (((structured OR systemic*) NEAR/3 (review* OR overview* OR synth*) NEAR/3 literature):ti,ab,kw) OR ((systemic* NEAR/1 review*):ti,ab,kw) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab,kw) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab,kw) OR (((literature NEAR/3 (review* OR overview*)):ti,ab,kw) AND (search*:ti,ab,kw OR database*:ti,ab,kw OR 'data base*':ti,ab,kw)) OR (('data extraction*':ti,ab,kw OR 'data source*':ti,ab,kw) AND ('study selection*':ti,ab,kw OR 'studies selection*':ti,ab,kw)) OR ('search strateg*':ti,ab,kw AND 'selection criteria*':ti,ab,kw) OR ('data source*':ti,ab,kw AND 'data synth*':ti,ab,kw) OR medline*:ti,ab,kw OR pubmed*:ti,ab,kw OR 'pub med*':ti,ab,kw OR embase:ti,ab,kw OR cochrane*:ti,ab,kw OR (((critical* OR rapid*) NEAR/2 (review* OR overview* OR synth*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synth*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynth*:ti,ab,kw OR 'meta synth*':ti,ab,kw OR 'review* of review*':ti,ab,kw |
1102861 |
|
#7 |
'randomized controlled trial'/exp OR 'clinical trial'/exp OR 'randomization'/de OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'triple blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ti,ab OR ((random* NEAR/2 (trial OR study)):ti,ab) OR ((random* NEAR/10 (trial OR trail OR 'clinical trial' OR 'clinical trail' OR 'clinical study' OR 'multicenter study' OR crossover OR 'cross over')):ti) OR (((randomised OR randomized) NEXT/6 study):ti) OR 'random* control* clinical trial':ti,ab OR 'random* control* clinical trail':ti,ab OR 'random* control* clinical study':ti,ab OR ((('single blind*' OR 'double blind*' OR 'triple blind*' OR 'quadruple blind*') NEAR/4 (study OR trial OR trail OR design)):ti,ab) OR placebo*:ti,ab OR randomly:ti,ab OR ((random* NEAR/3 distribut* NEAR/7 group*):ti,ab) OR (((pragmatic OR practical) NEXT/1 ('clinical trial' OR 'clinical trail')):ti,ab) OR ((('non inferiority' OR noninferiority OR superiority OR equivalence) NEXT/3 (trial OR trail)):ti,ab) OR ((random* NEAR/4 ('cross over*' OR crossover*)):ti,ab) OR ((phase NEAR/5 ('clinical trial' OR 'clinical trail' OR randomized OR randomised)):ti) OR ((random* NEAR/3 phase NEAR/3 (trial OR trail OR study)):ti,ab) |
3591679 |
|
#8 |
'major clinical study'/de OR 'clinical study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'cohort analysis'/de OR 'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti) OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab))) |
18029558 |
|
#9 |
#5 AND #6 - SR |
69 |
|
#10 |
#5 AND #7 NOT #9 - RCT |
185 |
|
#11 |
#5 AND #8 NOT (#9 OR #10) - Observationeel |
270 |
|
#12 |
#9 OR #10 OR #11 - Totaal |
524 |
Zoekstrategie Ovid/Medline 23 april 2025
|
# |
Searches |
Results |
|
1 |
exp Sleep Apnea, Central/ or exp Cheyne-Stokes Respiration/ or (csa adj3 (central* or sleep* or apn*)).ti,ab,kf. or (periodic* adj3 (breathing* or respiration*)).ti,ab,kf. or (central adj3 alveolar adj3 hypoventilat*).ti,ab,kf. or (central adj3 hypoventilat* adj3 syndrome*).ti,ab,kf. or (ondine* adj3 (syndrome or curse)).ti,ab,kf. or ((central* or complex or mixed) adj3 sleep* adj3 apn*).ti,ab,kf. or ((central* or complex or mixed) adj3 apn*).ti,ab,kf. or ((central or complex or mixed) adj3 sleep* adj3 disorder* adj3 breath*).ti,ab,kf. or cheyn* stoke*.ti,ab,kf. |
6818 |
|
2 |
exp Continuous Positive Airway Pressure/ or Positive-Pressure Respiration/mt or ((constant* or continuous* or continous*) adj3 (airway* or positive*) adj3 (pressure or ventilation)).ti,ab,kf. or cpap.ti,ab,kf. or cppb.ti,ab,kf. or cppv.ti,ab,kf. or ncpap.ti,ab,kf. |
24361 |
|
3 |
(treatment emergent central sleep apn* or treatmentemergent central sleep apn* or tecsa or te csa).ti,ab,kf. |
49 |
|
4 |
(1 and 2) or 3 |
971 |
|
5 |
4 not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) |
895 |
|
6 |
exp Meta-Analysis/ or exp Network Meta-Analysis/ or exp Systematic Review/ or (networkmeta analy* or networkmetaanaly* or metaanaly* or meta analy* or metanaly* or prisma or prospero or metaanali* or meta anali* or metanali*).ti,ab,kf. or ((systemati* or scoping or umbrella or structured literature) adj3 (review* or overview*)).ti,ab,kf. or ((structured or systemic*) adj3 (review* or overview* or synth*) adj3 literature).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 (review* or overview*)) and (search* or database* or data base*)).ti,ab,kf. or ((data extraction* or data source*) and (study selection* or studies selection*)).ti,ab,kf. or (search strateg* and selection criteria*).ti,ab,kf. or (data source* and data synth*).ti,ab,kf. or (medline* or pubmed* or pub med* or embase or cochrane*).ti,ab,kf. or cochrane.jw. or ((critical* or rapid*) adj2 (review* or overview* or synth*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synth*)) and (search* or database* or data base*)).ab. or metasynth*.ti,ab,kf. or meta synth*.ti,ab,kf. |
821525 |
|
7 |
exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
2873577 |
|
8 |
Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or exp cohort studies/ or epidemiologic studies/ or ((multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.)) or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ |
7990865 |
|
9 |
5 and 6 - SR |
49 |
|
10 |
(5 and 7) not 9 - RCT |
174 |
|
11 |
(5 and 8) not (9 or 10) - Observationeel |
232 |
|
12 |
9 or 10 or 11 - Totaal |
455 |