A prospective polysomnographic study on the evolution of complex sleep apnoea

Abstract

Complex sleep apnoea (CompSA) may be observed following continuous positive airway pressure (CPAP) treatment.In a prospective study, 675 obstructive sleep apnoea patients (mean age 55.9 yrs; 13.9% female) participated. Full-night polysomnography was performed at diagnosis, during the first night with stable CPAP and after 3 months of CPAP.12.2% (82 out of 675 patients) had initial CompSA. 28 of those were lost to follow-up. Only 14 out of the remaining 54 patients continued to satisfy criteria for CompSA at follow-up. 16 out of 382 patients not initially diagnosed with CompSA exhibited novel CompSA after 3 months. 30 (6.9%) out of 436 patients had follow-up CompSA. Individuals with CompSA were 5 yrs older and 40% had coronary artery disease. At diagnosis, they had similar sleep quality but more central and mixed apnoeas. On the first CPAP night and at follow-up, sleep quality was impaired (more wakefulness after sleep onset) for patients with CompSA. Sleepiness was improved with CPAP, and was similar for patients with or without CompSA at diagnosis and follow-up.CompSA is not stable over time and is mainly observed in predisposed patients on nights with impaired sleep quality. It remains unclear to what extent sleep impairment is cause or effect of CompSA.

Etiology of obstructive sleep apnoea syndrome

“…Cassel et al in their study, also observed a higher male to female ratio of 7:1. 6,7 Male preponderance was also observed in present study with male to female ratio of 3.2:1. Most patients with severe OSA were males (94.7%) and in females mild and moderate OSA were common (66.7%).…”

Central sleep apnea during continuous positive airway pressure therapy in obstructive sleep apnea patients: from the compliance to adaptation, maladaptation and reflexes

“…However, CPAP seems to be effective in some patients, while ineffective in others; CompSAS may develop de novo in 4% of OSAS patients treated with CPAP during follow up (17). Very few data are available on CPAP compliance, but there are suggestions that CompSAS patients may have a lower effect of CPAP on sleep as well as on breathing parameters, more dyspnea, poorer CPAP adherence and more often report spontaneous removal of the mask at night (18).…”

Sleep-related breathing disorders and non-invasive ventilation

“…It is characterized by recurrent episodes of partial (hypopnea) or complete (apnea), obstruction of the upper airway during sleep, and it is associated with episodes of arousal and/or oxyhemoglobin desaturation. 2 Symptoms of the syndrome are reported in Table 1. The pathophysiology of obstructive sleep apnea is still controversial.…”

“…Agata Lax, 1 Simona Colamartino, 2 Paolo Banfi, 1 Antonello Nicolini 2 N o n -c o m m e r c i a l u s e o n l y of the pharynx (see genioglossus) should produce a greater contraction to overcome the tendency of the pharyngeal wall to collapse (due to the negative pressure inside the cavity and pharynx). The supine position is dangerous obstruction as the tongue tends and occludes the rear wall of the oropharynx.…”