Clinical And Polisomnographic Features of Complex Sleep Apnea Syndrome

1. Clinical And Polisomnographic Features ofComplex Sleep Apnea Syndrome Handan INONU Tansu ULUKAVAK CIFTCI Oguz KOKTURK

2. 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

3. CPAP suppresses obstructive apneas • Apnea Hypopnea Index (AHI) is a high value due to central apneas

4. 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.

5. The classification of American Academy of Sleep Medicine (AASM) (ICSD-2) does not include CompSAS • CompSAS may be a different form of sleep apnea (???)

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

7. Pathophysiology of CompSAS ??? • Dysregulation of CO2 homeostasis • Instability in respiratory and/or cardiovascular control • Variations in baroreflex sensitivity Curr Opin Pulm Med 2005;11:485-93 Sleep Med 2006;7:474-79

8. 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

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

10. 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

11. 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

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

16. 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

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

18. Theophylline • Tyroksine • Metroksyprogesterone • Acetazolamide

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

20. Added Dead Space Chest 2003;123:1551-60

21. Objective • To compare clinical and polisomnographic (PSG) features between with OSAS and CompSAS

22. 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.

23. Results • There were 258 patients with OSAS and 12 with CompSAS • CPAP titration was prescribed in 83 cases

25. 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.