Abstract
Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour) persist or emerge when obstructive events are extinguished with positive airway pressure (PAP) and for which there is not a clear cause for the central apneas such as narcotics or systolic heart failure. The driving forces in the pathophysiology are felt to be ventilator instability associated oscillation in PaCO2 arterial partial pressure of Carbon Dioxide, continuous cositive airway pressure (CPAP) related increased CO2 carbon dioxide elimination, and activation of airway and pulmonary stretch receptors triggering these central apneas. The prevalence ranges from 0.56% to 18% with no clear predictive characteristics as compared to simple obstructive sleep apnea. Prognosis is similar to obstructive sleep apnea. The central apnea component in most patients on followup using CPAP therap, has resolved. For those with continued central apneas on simple CPAP therapy, other treatment options include bilevel PAP, adaptive servoventilation, permissive flow limitation and/or drugs.
Highlights
Obstructive sleep apnea syndrome (OSAS) affects a growing proportion of general population affecting both men (15%) and woman (5%) and is commonly known as “sleep disordered breathing” [1]
For some patients who undergo Continuous positive airway pressure (CPAP) treatment for OSAS, CPAP therapy leads to the development of recurrent central apneas or even clear periodic breathing
Complex sleep apnea syndrome is the diagnostic term for the form of central sleep apnea that persists or develops upon treatment of primarily obstructive sleep apnea with CPAP
Summary
Obstructive sleep apnea syndrome (OSAS) affects a growing proportion of general population affecting both men (15%) and woman (5%) and is commonly known as “sleep disordered breathing” [1]. Central sleep apneas syndrome is diagnosed in about 5% of those who undergo a sleep study. For some patients who undergo CPAP treatment for OSAS, CPAP therapy leads to the development of recurrent central apneas or even clear periodic breathing. This phenomenon of obstructive events or mixed central and obstructive events with short cycles of obstruction and the incomplete response to positive airway pressure (PAP) due to CPAP treatment related central events has been labeled “complex sleep apnea syndrome” (CompSAS) [6,7,8,9]
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