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Severe central apnea as side effect of Brilinta - Remfan - 09-02-2020
Have been using CPAP (ResMed S9 Autoset, pressure=4) for moderate obstructive sleep apnea for eight years, with reasonably decent control (AHI <5). The CPAP does induce mild central apnea in me, but total AHI <5.
On 05/17/20 started taking an anti-platelet drug, Brilinta (ticagrelor, 90mg b.i.d.), to prevent blood clots post-MI and placement of a stent. Three nights later I experienced severe sleep apnea (AHI >20), all of it as central apnea. The following night I changed the machine's setting from CPAP at a set pressure of 4, to APAP with a maximum pressure of 10. I thought this would allow the machine to determine the correct pressure response. Instead, I was dangerously pressure over-driven during the night, and the central apnea continued unabated. Woke up dazed, mouth open slack, feeling on beyond horrible. Realized that (for me) this severe central sleep apnea could not be resolved with CPAP or APAP. Returned to CPAP at set pressure=4.8. Reduced dosage of Brilinta to 60mg b.i.d., and the central sleep apnea began to decline, resolving in about three weeks.
Central sleep apnea is an uncommon side effect of Brilinta, not listed on the package insert. There are a few case reports in the medical journals. Had I not been on CPAP therapy with a device capable of reporting the types of apnea events, I would have never recognized what was happening. That level of central apnea could have resulted in severe cardiac complications. The failure of the APAP algorithm to find a correct pressure compounded the hazard.
Hope this report alerts readers to an unusual drug hazard, and guides toward a safe resolution. Could any readers advise on why APAP resulted in being pressure over-driven? And on how one might have responded better? Offered with thanks for the collective knowledge of this community.
RE: Severe central apnea as side effect of Brilinta - OpalRose - 09-02-2020
An APAP usually won't respond to Central Apnea as it cannot treat it. If the pressure shot up, it may be due to other events like Flow Limitation, Reras, and Snores.
You could post an OSCAR chart for us to look at and we could advise on settings.
Also, there are many medications out there that can have a negative affect on your AHI readings. Discuss this with you Doctor, but don't stop or change dosage without docs knowledge.
Follow the links in my signature line to organize and post a chart here.
RE: Severe central apnea as side effect of Brilinta - Remfan - 09-02-2020
Thank you! Is there a version of OSCAR for Mac computers? I'm not using any tracking software currently.
Sound advice to consult with doc re: med changes.
RE: Severe central apnea as side effect of Brilinta - SarcasticDave94 - 09-02-2020
OSCAR has a Mac version listed for download.
RE: Severe central apnea as side effect of Brilinta - Remfan - 09-02-2020
Perfect!
RE: Severe central apnea as side effect of Brilinta - Sleeprider - 09-02-2020
If the central apnea is continuing, the correct therapy is ASV (adaptive servo ventilator) which provides a low exhale pressure to keep your airway patent from obstruction, then uses adaptive pressure support to treat hypopnea and central apnea and maintain your normal minute vent. It lets you breath spontaneously, but it causes you to breathe when you don't. There is effective treatment if you are continuing the medication or continuing to have symptoms. Have you discussed this problem with your doctors?
RE: Severe central apnea as side effect of Brilinta - Remfan - 09-02-2020
Yes, I did discuss it with my doc (albeit after the fact of reducing dosage). And since that led to the resolution of the central apnea (as well as resolution of some spontaneous bleeding), he concurred and did not offer a different or better course of action.
And yes, ASV would have been the best treatment of the central apnea had it not resolved. Fortunately, I am entirely off Brilinta now. Just an 81mg aspirin/day.
Thank you for sharing your guidance!
RE: Severe central apnea as side effect of Brilinta - Sleeprider - 09-03-2020
Glad to hear you got this resolved, and I hope the information is useful to others.
RE: Severe central apnea as side effect of Brilinta - Ivy woods - 06-02-2023
Exact same thing happened to my husband after mi. Switching ticagrelor helped greatly. Turning cpap from 11 to 5.4 has almost resolved it. Sleep study was useless. Cardiologist was useless. Went from <5 ahi all obstructive to almost 50 all central apneas post mi and stents.
RE: Severe central apnea as side effect of Brilinta - Ivy woods - 06-02-2023
If your central apneas have an identifiable cause like heart failure, you should treat the heart failure. If drugs are causing them, you should switch them or adjust the dose. If you have no idea what is causing the central apneas that’s a different situation. But this man knows the cause and corrected it.