FIG. 37:  This Figure lists some of the risk factors reported for TE-CSA: male gender, being leaner or having a lower BMI; having fragmented sleep or mixed or central apneas during the diagnostic portion of polysomnography tends to suggest risk for TE-CSA.  Also conditions such as CHF, atrial fibrillation, and opioids can be associated with TE-CSA.

Up to 40–50% of patients with systolic heart failure and CSR during the diagnostic portion of the study will end up having TE-CSA.  Severe OSA may be associated with this condition (since PAP opens the upper airway, which may inhibit respiratory drive), and a baseline state of hypocapnia is also a risk factor. 

With respect to overtitration, no systematic study has found that higher CPAP pressures lead to TE-CSA.  However, anecdotal experience and some reports in CHF patients have shown that higher CPAP pressures may lead to or be associated with TE-CSA.  The significance of this is unclear, especially when balancing the effectiveness of OSA treatment against the risk of TE-CSA.