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Review
. 2014:2014:798487.
doi: 10.1155/2014/798487. Epub 2014 Feb 16.

Complex sleep apnea syndrome

Muhammad Talha Khan  1 , Rose Amy Franco  1
Affiliations
Review

Complex sleep apnea syndrome

Muhammad Talha Khan et al. Sleep Disord. 2014.

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.

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Figures

Figure 1
Figure 1
(a) Diagnostic polysomnogram showing obstructive events (arrows). Leads from top to bottom; eye, EEG, chin, ECG, snore, nasal pressure, thermal airflow, thoracic and abdominal effort, legs movement, saturation, and heart rate. (b) Development of central events on CPAP therapy (arrows). Leads from top to bottom; EEG, eye, chin, ECG, snore, legs movement, CPAP, flow, thoracic and abdominal effort, IPAP, saturation, leak, respiratory rate, and heart rate.
Figure 2
Figure 2
Schematic representation of pathogenesis of complex sleep apnea syndrome.
Figure 3
Figure 3
Patient on adaptive servoventilation. Resolution of central events which were noted on CPAP therapy.
Figure 4
Figure 4
A schematic representation of treatment modalities of complex sleep apnea.
See this image and copyright information in PMC

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