Clinical And Polisomnographic Features of

Complex Sleep Apnea Syndrome

Handan INONU Tansu ULUKAVAK CIFTCI Oguz KOKTURK

Complex Sleep Apnea Syndrome (CompSAS)

Complex Sleep Apnea Syndrome (CompSAS) is a case characterized by appearing of central apneas or Cheyne-Stokes breathing pattern in some patients of Obstructive Sleep Apnea Syndrome (OSAS) which were applicated Continuous Positive Airway Pressure (CPAP)

Sleep Breath 2008;12(2):135-9 Sleep Med 2006,7:474-9 Sleep 2006;29(9):1203-9

CPAP suppresses obstructive apneas

Apnea Hypopnea Index (AHI) is a high value due to central apneas

In a study which 219 cases were evaluated

OSAS 84% CompSAS 15% CSA 0.4%

Morgenthaler T. Complex Sleep Apnea Syndrome: Is it a Unique Clinical Syndrome? Sleep 2006; 29(9): 1203-9.

The classification of American Academy of Sleep Medicine (AASM) (ICSD-2) does not include CompSAS

CompSAS may be a different form of sleep apnea (???)

Clinical features of patients with CompSAS are similar to those of OSAS, while the breathing patterns resemble to those of Central Sleep Apnea (CSA)

Pathophysiology of CompSAS ???

Dysregulation of CO2 homeostasis Instability in respiratory and/or cardiovascular

control Variations in baroreflex sensitivity

Curr Opin Pulm Med 2005;11:485-93Sleep Med 2006;7:474-79

Treatment

* The optimal treatment of CompSAS is not known

Positive Airway Pressure (PAP) therapy Supplement oxygen Pharmcotherapy Minimizing of hypocapnia

Curr Opin Pulm Med 2005;11:485-93

Positive Airway Pressure (PAP) therapy Supplement oxygen Pharmcotherapy Minimizing hypocapnia

In one study, 13 CompSAS patients treated with CPAP therapy, about half patients eventually normalize AHI, however there is an equally proportion of patients who continue to suffer from CSA activity on CPAP

Sleep Breath 2008;12(2):135-9

The results of a study which the effects of NPPV and ASV were compared with to those of CPAP in CompSAS are as follows; Both of NPPV and ASV have the evident

recovering effects on AHİ and ARİ than CPAP

The effect of ASV was more superior than NPPV

Sleep 2007;30(4):468-75

Positive Airway Pressure (PAP) therapy Supplement oxygen Pharmcotherapy Minimizing hypocapnia

Studies have shown that oxygen supplementation during sleep reduces the number of central respiratory events and decreases the overnight sympathetic activity in CHF-CSA patients

Sleep 1999;22:1101-6

Positive Airway Pressure (PAP) therapy Supplement oxygen Pharmcotherapy Minimizing hypocapnia

Theophylline Tyroksine Metroksyprogesterone Acetazolamide

Positive Airway Pressure (PAP) therapy Supplement oxygen Pharmcotherapy Minimizing hypocapnia

Added Dead Space

Chest 2003;123:1551-60

Objective

To compare clinical and polisomnographic (PSG) features between with OSAS and CompSAS

Method

Polisomnographic records evaluated a total of 270 patients, retrospectively

CPAP titration was prescribed in patients with AHI ≥15

Patients who developed a central AHI ≥ 5 following titration PSG are diagnosed as CompSAS.

Results

There were 258 patients with OSAS and 12 with CompSAS

CPAP titration was prescribed in 83 cases

Chracteristics CompSAS OSAS P valueAge 55.8 ± 10.6 51.2 ± 10.2 0.155BMI 31.5 ± 6.2 30 ± 5.5 0.405ESS 8.09 ± 5.3 11.7 ± 5.3 0.041Diagnostic AHI 57.14 ± 35.2 37.7 ± 32.3 0.026ARI 25.6 ± 16.8 21.9 ± 18.7 0.224Sleep Efficiency 71.3 ± 17.6 74.3 ± 13.3 0.604Baseline O2 sat 94.18 ± 2.08 94.8 ± 1.5 0.297Average O2 sat 87.1 ± 4.2 89.3 ± 4.6 0.027

Minimum O2 sat 68.9 ± 11.3 76.2 ± 9.9 0.017

% Desaturation 60.05 ± 37.8 38.5 ± 35.2 0.042pO2 71.7 ± 12.3 76.1 ± 11.2 0.296pCO2 35 ± 4.1 36.2 ± 4.4 0.192Residual AHİ 9.8 ± 5.8 3.1 ± 4.7 <0.001Number of central apneas 27.3 ± 18.7 2.4 ± 2.6 <0.001Duration of central apneas

15.5 ± 1.8 9.3 ± 6.8 <0.001

CPAP pressure 8.4 ± 1.4 8.8 ± 1.5 0.380CHF %16.6 %2.4 0.048CKF %8.3 %0 0.047HT %58.3 %44.5 0.386CAD %16.6 %13.4 0.670Stroke %0 %0.4 1.000DM %33.3 %16.2 0.129

Discussion

The results of our study revealed that; The rate of CHF was significantly higher,

the lower average and minimum values of oxygen saturation in diagnostic PSG in group of CompSAS

Irregularity in the mechanisims of respiratory and/or cardiovascular control may be responsible in the pathophysiology of CompSAS according to above two results.