Table 1.

Summary of Potential Treatment Strategies and Their Effectiveness for Hypercapnic CSA^*

Variables	Intervention	Benefits	Limitations	Level of Evidence
OHS (won’t breathe)	Weight loss	Likely ↓ in SDB and other health-related benefits	Difficult to achieve	No published data in this population
	CPAP	Variable ↓ in SDB; ↑ QOL	Not effective for all patients	Several small, short-term non- RCTs73–75
	Bilevel PAP/bilevel PAP plus backup mode	Normalizes AHI; ↑QOL; ↑ Pao2; ↓Paco2	Long-term effectiveness unknown	Several, small, short-term non- RCTs73,76 and one small RCT77
	O2	May ↓ hypoventilation in certain patients	Very limited data available	Case report78
	Progesterone	May improve daytime gas exchange; ↑ hypercapnic chemoresponsiveness	Effects on AHI unknown in this population and no long- term safety data	One small, moderate-term non- RCT79
Narcotic-induced CSA (can’t breathe)	Dose reduction	Likely ↓ in SDB	Difficult to achieve	Case report (Fig 2)
Impaired respiratory motor control	Bilevel PAP	Likely ↓ in SDB	Limited data available, and patient tolerance may be poor	Several non-RCTs (refer to Malhotra et al5 and Schneerson et al76 for detail)

^*PAP = positive airway pressure; QOL = quality of life; RCT = randomized control trial; ↑ = increase; ↓ = decrease.