Abstract
Patients with complex sleep apnea syndrome (CompSAS) have obstructive sleep apnea but develop troublesome central sleep apnea activity or Cheyne–Stokes breathing when provided continuous positive airway pressure (CPAP) therapy. We examined whether CompSAS activity persists with long-term CPAP treatment. We retrospectively identified all patients with CompSAS who underwent two therapeutic polysomnograms (PSGs) separated by at least 1 month during 2003–2005. We compared PSG findings between the initial and follow-up study and noted clinical responses to therapy. We identified 13 CompSAS patients meeting criteria. Most follow-up PSGs were ordered after an abnormal overnight oximetry on CPAP or because of CPAP intolerance after 195 (49–562) days. The residual apnea–hypopnea index (AHI) on CPAP decreased from 26 (23–40) on the first PSG to 7 (3–21.5) on the follow-up PSG. Only seven patients reached AHI < 10 and 6 had AHI ≥ 10 (“CPAP nonresponders”) at follow-up. “CPAP nonresponders” were sleepier (Epworth Sleepiness Score 13 [12.5–14] vs 9 [6–9.5], p = 0.03) and trended toward lower body mass index (29.7 [28.6–31.6] vs 34.3 [32.5–35.1], p = 0.06). Both groups were equally compliant with CPAP therapy. Although the AHI tends to improve over time in CompSAS patients treated with CPAP, in this retrospective study nearly half-maintained a persistently elevated AHI. A prospective trial is merited to determine the optimal treatment for these patients.
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This work was performed with support from Mayo Clinic Foundation.
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Kuzniar, T.J., Pusalavidyasagar, S., Gay, P.C. et al. Natural course of complex sleep apnea—a retrospective study. Sleep Breath 12, 135–139 (2008). https://doi.org/10.1007/s11325-007-0140-z
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DOI: https://doi.org/10.1007/s11325-007-0140-z