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Neuroscience and Behavioral Physiology

, Volume 49, Issue 1, pp 48–53 | Cite as

Complex Sleep Apnea

  • A. D. Pal’manEmail author
Article

The term complex sleep apnea syndrome (Comp-SAS) refers to a specific variant of respiratory impairment during sleep characterized by the appearance or significant increases in the number of episodes of central apnea and hypopnea after starting CPAP therapy for obstructive sleep apnea syndrome (OSAS). The mechanisms producing Comp-SAS are not fully understood. It is possible that respiration with positive pressure and elimination of pharyngeal obstruction in some patients lead to increases in pulmonary ventilation and decreases in PaCO2 to below the individual threshold required for stimulating respiration. The prevalence of Comp-SAS is 5–20% of patients with OSAS receiving CPAP therapy. Significant clinical predictors for Comp-SAS have not been established, though this respiratory disorder is known to occur more frequently in male patients, older patients, those with severe OSAS, and those with cardiovascular diseases such as ischemic heart diseases, atrial fibrillation, or chronic heart failure (CHF). In most cases, Comp-SAS settles spontaneously after 1–2 months of regular CPAP therapy. If positive pressure treatment has no effect, other contemporary treatment methods can be used, such as adaptive servo ventilation or BPAP treatment with controlled respiratory frequency, though these are contraindicated in systolic heart failure. The question of whether treatment of patients with Comp-SAS is obligatory when the course of illness is straightforward and symptom-free remains open.

Keywords

sleep apnea obstructive sleep apnea central sleep apnea CPAP adaptive servo ventilation 

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References

  1. 1.
    G. S. Gilmartin, R. W. Daly, and R. J. Thomas, “Recognition and management of complex sleep-disordered breathing,” Curr. Opin. Pulm. Med., 11, No. 6, 485– 493 (2005),  https://doi.org/10.1097/01.mcp.0000183061.98665.b0.CrossRefPubMedGoogle Scholar
  2. 2.
    T. J. Kuzniar, R. Kovacevic-Ristanovic, and T. Freedom, “Complex sleep apnea unmasked by the use of a mandibular advancement device,” Sleep Breath., 15, No. 2, 249–252 (2011),  https://doi.org/10.1007/s11325-010-0459-8.CrossRefPubMedGoogle Scholar
  3. 3.
    S. Corcoran, V. Mysliwiec, A. S. Niven, and D. Fallah, “Development of central sleep apnea after maxillofacial surgery for obstructive sleep apnea,” J. Clin. Sleep Med., 5, No. 2, 151–153 (2009).PubMedPubMedCentralGoogle Scholar
  4. 4.
    P. C. Gay, “Complex sleep apnea: it really is a disease,” J. Clin. Sleep Med., 4, 403–405 (2008).PubMedPubMedCentralGoogle Scholar
  5. 5.
    Y. Endo, M. Suzuki, Y. Inoue, M. Sato, K. Namba, M. Hasegawa, and M. Matsuura, “Prevalence of complex sleep apnea among Japanese patients with sleep apnea syndrome,” Tohoku J. Exp. Med., 215, No. 4, 349–354 (2008),  https://doi.org/10.1620/tjem.215.349.CrossRefPubMedGoogle Scholar
  6. 6.
    T. Dernaika, M. Tawk, S. Nazi, W. Younis, and G. T. Kinasewitz, “The significance and outcome of continuous positive airway pressure-related central sleep apnea during split-night sleep studies,” Chest, 132, No. 1, 81–87 (2007),  https://doi.org/10.1378/chest.06-2562.CrossRefPubMedGoogle Scholar
  7. 7.
    S. Javaheri, J. Smith, and E. Chung, “The prevalence and natural history of complex sleep apnea,” J. Clin. Sleep Med., 5, No. 3, 205–211 (2009).PubMedPubMedCentralGoogle Scholar
  8. 8.
    T. I. Morgenthaler, V. Kagramanov, V. Hanak, and P. A. Decker, “Complex sleep apnea syndrome: is it a unique clinical syndrome?” Sleep, 29, No. 9, 1203–1209 (2006).CrossRefGoogle Scholar
  9. 9.
    S. Lehman, N. A. Antic, C. Thompson, P. G. Catcheside, J. Mercer, and R. D. McEvoy, “Central sleep apnea on commencement of continuous positive airway pressure in patients with a primary diagnosis of obstructive sleep apnea-hypopnea,” J. Clin. Sleep Med., 3, No. 5, 462–466 (2007).PubMedPubMedCentralGoogle Scholar
  10. 10.
    W. Cassel, S. Canisius, H. F. Becker, S. Leistner, T. Ploch, A. Jerrentrup, C. Vogelmeier, U. Koehler, and J. Heitmann, “A prospective polysomnographic study on the evolution of complex sleep apnoea,” Eur. Respir. J., 38, No. 2, 329–337 (2011),  https://doi.org/10.1183/09031936.00162009.CrossRefPubMedGoogle Scholar
  11. 11.
    T. J. Kuzniar, K. Kasibowska-Kuzniar, D. W. Ray, and T. Freedom, “Clinical heterogeneity of patients with complex sleep apnea syndrome,” Sleep Breath., 17, No. 4, 1209–1214 (2013),  https://doi.org/10.1007/s11325-013-0825-4.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    J. Wang, Y. Wang, J. Feng, B. Y. Chen, and J. Cao, “Complex sleep apnea syndrome,” Pat. Prefer. Adherence, 7, 633–641 (2013),  https://doi.org/10.2147/PPA.S46626.CrossRefGoogle Scholar
  13. 13.
    M. T. Khan and R. A. Franco, “Complex sleep apnea syndrome,” Sleep Disord., 2014, 798487 (2014),  https://doi.org/10.1155/2014/798487.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    D. Yumino and T. D. Bradley, “Central sleep apnea and Cheyne–Stokes respiration,” Proc. Am. Thorac. Soc., 5, No. 2, 226–236 (2008),  https://doi.org/10.1513/pats.200708-129MG.CrossRefPubMedGoogle Scholar
  15. 15.
    D. Yumino and T. D. Bradley, “Central sleep apnea and Cheyne–Stokes respiration,” Proc. Am. Thorac. Soc., 5, No. 2, 226–236 (2008),  https://doi.org/10.1513/pats.200708-129MG.CrossRefPubMedGoogle Scholar
  16. 16.
    R. N. Aurora, S. Chowdhuri, K. Ramar, S. R. Bista, K. R. Casey, C. I. Lamm, D. A. Kristo, J. M. Mallea, J. A. Rowley, R. S. Zak, and S. L. Tracy, “The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses,” Sleep, 35, No. 1, 17–40 (2012),  https://doi.org/10.5665/sleep.1580.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    J. S. Allam, E. J. Olson, P. C. Gay, and T. I. Morgenthaler, “Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes,” Chest, 132, No. 6, 1839–1846 (2007),  https://doi.org/10.1378/chest.07-1715.CrossRefPubMedGoogle Scholar
  18. 18.
    S. Nakamura, K. Asai, Y. Kubota, K. Murai, H. Takano, Y. T. Tsukada, and W. Shimizu, “Impact of sleep-disordered breathing and efficacy of positive airway pressure on mortality in patients with chronic heart failure and sleep-disordered breathing: a meta-analysis,” Clin. Res. Cardiol., 104, No. 3, 208–216 (2015),  https://doi.org/10.1007/s00392-014-0774-3.CrossRefPubMedGoogle Scholar
  19. 19.
    X. Wu, C. Fu, S. Zhang, Z. Liu, S. Li, and L. Jiang, “Adaptive servoventilation improves cardiac dysfunction and prognosis in heart failure patients with sleep-disordered breathing: a meta-analysis,” Clin. Respir. J. (2015), http://onlinelibrary.wiley.com/doi/10.1111/crj.12390/pdf  https://doi.org/10.1111/crj.12390.
  20. 20.
    M. R. Cowie, H. Woehrle, K. Wegscheider, et al., “Adaptive servo-ventilation for central sleep apnea in systolic heart failure,” N. Engl. J. Med., 373, No. 12, 1095–1105 (2015),  https://doi.org/10.1056/NEJMoa1506459.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    R. N. Aurora, S. R. Bista, K. R. Casey, S. Chowdhuri, D. A. Kristo, J. M. Mallea, K. Ramar, J. A. Rowley, R. S. Zak, and J. L. Heald, “Updated adaptive servo-ventilation recommendations for the 2012 AASM guideline: ‘The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses’,” J. Clin. Sleep Med., 12, No. 5, 757-761 (2016),  https://doi.org/10.5664/jcsm.5812.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    T. Dernaika, M. Tawk, S. Nazir, W. Younis, and G. T. Kinasewitz, “The significance and outcome of continuous positive airway pressure-related central sleep apnea during split-night studies,” Chest, 132, No. 1, 81–87 (2007),  https://doi.org/10.1378/chest.06-2562.CrossRefPubMedGoogle Scholar
  23. 23.
    T. I. Morgenthaler, T. J. Kuzniar, L. F. Wolfe, L. Willes, W. C. McLain, and R. Goldberg, “The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy,” Sleep, 37, No. 5, 927–934 (2014),  https://doi.org/10.5665/sleep.3662.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    R. N. Glidewell, W. C. Orr, and N. Imes, “Acetazolamide as an adjunct to CPAP treatment: a case of complex sleep apnea in a patient on long-acting opioid therapy,” J. Clin. Sleep Med., 5, No. 1, 63–64 (2009).PubMedPubMedCentralGoogle Scholar
  25. 25.
    P. Bordier, A. Lataste, P. Hofmann, F. Robert, and G. Bourenane, “Nocturnal oxygen therapy in patients with chronic heart failure and sleep apnea: a systematic review,” Sleep Med., 17, 149–157 (2016),  https://doi.org/10.1016/j.sleep.2015.10.017.CrossRefPubMedGoogle Scholar
  26. 26.
    P. A. Lanfranchi, A. Braghiroli, E. Bosimini, G. Mazzuero, R. Colombo, C. F. Donner, and P. Giannuzzi, “Prognostic value of nocturnal Cheyne–Stokes respiration in chronic heart failure,” Circulation, 99, No. 11, 1435–1440 (1999),  https://doi.org/10.1161/01.CIR.99.11.1435.CrossRefPubMedGoogle Scholar
  27. 27.
    P. A. Lanfranchi, V. K. Somers, A. Braghiroli, U. Corra, E. Eleuteri, and P. Giannuzzi, “Central sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk,” Circulation, 107, No. 5, 727–732 (2003),  https://doi.org/10.1161/01.CIR.0000049641.11675.EE.CrossRefPubMedGoogle Scholar
  28. 28.
    R. D. McEvoy, N. A. Antic, and E. Heeley, “CPAP for prevention of cardiovascular events in obstructive sleep apnea,” N. Engl. J. Med., 375, No. 10, 919-931 (2016),  https://doi.org/10.1056/NEJMoa1606599.CrossRefPubMedGoogle Scholar
  29. 29.
    E. O. Bixler, A. N. Vgontzas, J. Gaines, J. Fernandez-Mendoza, S. L. Calhoun, and D. Liao, “Moderate sleep apnoea: a ‘silent’ disorder, or not a disorder at all?” Eur. Respir. J., 47, No. 1, 23–26 (2016),  https://doi.org/10.1183/13993003.01955-2015.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Sechenov First Moscow State Medical University (Sechenov University)Russian Ministry of HealthMoscowRussia

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