Early detection of emergent central apnoea in patients on positive airway pressure therapy: A five-year telemonitoring cohort study

Introduction Treatment-emergent central sleep apnoea (TE-CSA) during positive airway pressure (PAP) therapy is recognised, yet its onset timing and contributing factors remain unclear. This study aimed to ascertain the onset time of TE-CSA via telemonitoring (TM) and identify associated factors.Methods A retrospective cohort of 4,021 obstructive sleep apnoea (OSA) patients treated with PAP and monitored via TM from 2017 to 2022 was analysed. TE-CSA was defined as a residual apnoea-hypopnoea index (AHI) >15 with 50% or more central events. Moreover, if the obstructive apnoea index (OAI) was > 5, patients were excluded. Patients with a central apnoea index (CAI) ≥5 at baseline were excluded. TE-CSA was categorised as transient (<12 weeks), prolonged (12–24 weeks), or persistent (>24 weeks without resolution during the follow-up period). Kaplan–Meier analysis assessed time to TE-CSA onset. A nested case-control study evaluated demographic, cardiovascular, cerebrovascular, sedative use, and PAP treatment type as risk factors.Results TE-CSA occurred in 171 (4.3%, 95% CI: 3.7–4.9) patients, predominantly prolonged (90.6%), with transient (5.9%) and persistent (3.5%) forms. TE-CSA primarily emerged within the first 60 days of PAP therapy. Multivariate analysis identified older age (Odds Ratio (OR) = 1.03, p < 0.001) and male sex (OR = 2.35, p = 0.003) as significant predictors of TE-CSA development.Conclusion Telemonitoring detected that TE-CSA onset was most commonly identified within the first 2 months of PAP therapy. Older age and male sex are key predictors. Early detection through TM could facilitate timely interventions, although therapeutic adjustments were implemented throughout the observation period and may have influenced the temporal patterns observed.