Complex Sleep Apnea

Central and obstructive apneas may occur in the same individual, either simultaneously within a single breath as a mixed apnea, or as sequential breathing events (33). The majority of OSA patients can be expected to respond favorably to CPAP but CPAP often initially exaggerates central sleep apnea (CSA) and some patients identified as having OSA, develop frequent central apneas and/or Cheyne-Stokes respiratory (CSR) pattern after application of CPAP. This is an increasingly recognized but not new clinical problem encountered when patients with significant OSA develop CSA when exposed to CPAP (34,35). These patients that develop new or very prominent CSA during CPAP titration are now referred to as complex sleep apnea (CompSA) and from a consecutive series of 133 patients referred to a sleep lab for OSA, 34 (25.6%) proved to have CompSA (36).

In this study, the mean age (near 55 years) and total diagnostic AHI (near 30 events/hour) were similar between the groups but there were a few distinguishing features between the patients with OSA versus CompSA. The CompSA patients were more likely to be males (82.4% vs. 63.9%; p = 0.03) and the OSA patients tended to be slightly heavier (36 ± 10.3 kg/m2 vs. 33 ± 5.9 kg/m2; p < 0.03). By definition, CompSA patients had a significantly higher AHI during a standard CPAP titration (CompSA vs. OSA AHI on CPAP = 24.6 ± 21.6 events/hour vs. 2.1 ± 2.7 events/hour; p < 0.0001) with most or all the residual difference related to the central apneas that emerged on CPAP (19.4 ± 19.0 vs. 2.1 ± 2.7 central events/hour; p < 0.0001). In a different investigation selecting patients who were chosen to undergo BPAP for a variety of reasons, many patients showed a CompSA like response to BPAP (rarely was a backup rate added) but it was not possible to discern an incidence estimate from the data provided (37).

Sleep Apnea

Sleep Apnea

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