What is the most appropriate recommendation for a patient with 90 documented central apneas during a split night study?

For a patient who has documented 90 central apneas during a split-night sleep study, the most appropriate recommendation is Bilevel Positive Airway Pressure (BiPAP). This method is particularly beneficial for central sleep apnea, as it can provide varying levels of pressure support for both inhalation and exhalation.

BiPAP is more effective than other treatment options in patients with central apneas because it not only helps maintain airway patency but also assists in ventilatory support, which is crucial given that central apneas originate from a lack of respiratory effort rather than from airway obstruction. By providing the necessary pressure support during the respiratory cycle, BiPAP can help stabilize the patient's breathing patterns and reduce the frequency of apneas.

Continuous Positive Airway Pressure (CPAP) and Auto-Adjusting Positive Airway Pressure (APAP) therapies are typically more suited for obstructive sleep apnea rather than central apneas, as they primarily focus on keeping the airway open without the ability to assist in ventilation. Oxygen therapy alone does not address the underlying mechanics of central apnea, which makes it an inadequate stand-alone treatment in this scenario. Therefore, BiPAP stands out as the most effective choice for managing this patient’s documented central apneas.