Characteristics of Japanese Patients with Complex Sleep Apnea Syndrome: A Retrospective Comparison with Obstructive Sleep Apnea Syndrome

Yaegashi, Hironobu; Abe, Hidetoshi; Orii, Kyoko; S, Eda; Kubo, Keishi

doi:10.2169/internalmedicine.48.1459

Cited by 40 publications

(32 citation statements)

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“…Four hundred sixty-seven articles were screened, 58 were evaluated in full-text form, and 14 studies met the established criteria (Brillante et al 2012;Koo et al 2012;Kushida et al 2011;Yaegashi et al 2009;Osuna et al 2008;Drake et al 2003;Verma et al 2001;Randerath et al 2001;Parrino et al 2000;Yamashiro and Kryger 1995;Lamphere et al 1989;Aldrich et al 1989;Issa and Sullivan 1986;Collard et al 1996). Eleven of the 14 studies noted a statistically significant increase in amount of REM sleep during the titration night, compared to the baseline sleep study.…”

Section: Resultsmentioning

confidence: 99%

“…Consequently, sleep becomes more consolidated with an increase in the duration of REM sleep compared to the diagnostic study. REM rebound (Brillante et al 2012;Koo et al 2012;Kushida et al 2011;Yaegashi et al 2009;Osuna et al 2008;Drake et al 2003;Verma et al 2001;Randerath et al 2001;Parrino et al 2000;Yamashiro and Kryger 1995;Lamphere et al 1989;Aldrich et al 1989;Issa and Sullivan 1986;Collard et al 1996) is the polysomnographic phenomenon of substantial increase in duration of REM sleep in a patient with untreated OSA when first undergoing CPAP titration. Similarly, some patients may exhibit an increase in the duration of slow wave sleep called slow wave sleep rebound (Brillante et al 2012;Osuna et al 2008;Verma et al 2001).…”

Section: Introductionmentioning

confidence: 99%

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Rapid Eye Movement (REM) rebound on initial exposure to CPAP therapy: a systematic review and meta-analysis

Nigam

Camacho

Riaz

2017

Sleep Science Practice

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Objective: Rapid Eye Movement (REM) rebound is a polysomnographic phenomenon where a substantial increase in REM sleep is noted in patients with untreated obstructive sleep apnea (OSA) when first undergoing continuous positive airway pressure (CPAP) titration. The objectives of this study are to determine: 1) the percentage of patients experiencing REM rebound during CPAP titrations, 2) to quantify the relative increase in REM sleep duration and 3) to identify if there are patient variables associated with REM rebound. Methods: Four databases (including PubMed/Medline) were systematically searched through March 12, 2017.Results: Four hundred sixty-seven articles were screened, 58 were reviewed in full-text form and 14 studies met the criteria for inclusion in this review. Eleven of the fourteen studies noted a statistically significant increase in amount of REM sleep during the titration night, compared to baseline sleep study. Pre-and post-CPAP REM sleep duration percentage means ± standard deviations (M ± SD) in 1119 patients increased from 13.8 ± 8.2% to 20.0 ± 10.1%; random effects modeling demonstrated a mean difference of 7.86 (%) [95% CI 5.01, 10.70], p-value <0.00001, corresponding to a 57% relative increase in REM sleep duration. The standardized mean difference (SMD) is 0.90 [95% CI 0.59, 1.22], representing a large magnitude of effect. Conclusions: In studies reporting REM rebound, the REM sleep duration increased by 57% during the first CPAP titration night compared to the baseline sleep study. The prevalence of REM rebound varied between 23 and 46%. A low amount of REM sleep on the diagnostic PSG predicted REM rebound.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rapid Eye Movement (REM) rebound on initial exposure to CPAP therapy: a systematic review and meta-analysis

Nigam

Camacho

Riaz

2017

Sleep Science Practice

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“…An explanation could be that males have a higher hypercapnic ventilatory response, and are therefore more predestinated to develop CompSAS. Not all studies came to the same conclusion [19]. In general, patients with OSAS or CompSAS do not show statistically significant differences in age, level of sleepiness (based on Epworth scale) [5,9,11,31], lung function parameters (i.e.…”

Section: Clinical Presentationmentioning

confidence: 94%

“…This mechanism protects the lungs against overexpansion, and is called the Hering-Breuer reflex. A final hypothesis is based on the fact that CPAP will worsen sleep quality in some patients [16,18,19]. The frequent changes from sleep to wake and from wake to sleep lead to instability in the ventilatory control system.…”

Section: Pathogenesismentioning

confidence: 99%

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Complex sleep apnoea syndrome

Verbraecken

2013

breathe

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SummaryComplex sleep apnoea syndrome (CompSAS) is a type of central apnoea characterised by the development or persistence of central apnoeas or hypopnoeas during application of continuous positive airway pressure (CPAP; central apnoea index ≥5 events·h−1). These patients present with predominantly obstructive apnoeas during diagnostic sleep studies. No clinical characteristics have been identified which can distinguish them from patients with a normal response during CPAP titration. Probably, this pattern is provoked by the application of high CPAP pressures in obstructive sleep apnoea syndrome patients with enhanced chemoreceptor sensitivity, or in patients with pronounced sleep fragmentation. Negative feedback is sent to the respiratory centre,viathe Hering-Breuer reflex, which can lead to central apnoea. However, these explanations remain hypothetical at present. In a broader perspective, any occurrence of significant central apnoea activity during attempts to restore airway patency could be classified as CompSAS. Treatment modalities consist of prevention on the one hand (avoidance of high pressures and permissive flow limitation), and advanced ventilation techniques (adaptive servo ventilation) on the other hand.

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Central Sleep Apnea

Javaheri

2013

Comprehensive Physiology

189

128

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Neurophysiologically, central apnea is due to a temporary failure in the pontomedullary pacemaker generating breathing rhythm. As a polysomnographic finding, central apneas occur in many pathophysiological conditions. Depending on the cause or mechanism, central apneas may not be clinically significant, for example, those that occur normally at sleep onset. In contrast, central apneas occur in a number of disorders and result in pathophysiological consequences. Central apneas occur commonly in high-altitude sojourn, disrupt sleep, and cause desaturation. Central sleep apnea also occurs in number of disorders across all age groups and both genders. Common causes of central sleep apnea in adults are congestive heart failure and chronic use of opioids to treat pain. Under such circumstances, diagnosis and treatment of central sleep apnea may improve quality of life, morbidity, and perhaps mortality. The mechanisms of central sleep apnea have been best studied in congestive heart failure and hypoxic conditions when there is increased CO2 sensitivity below eupnea resulting in lowering eupneic PCO2 below apneic threshold causing cessation of breathing until the PCO2 rises above the apneic threshold when breathing resumes. In many other disorders, the mechanism of central sleep apnea (CSA) remains to be investigated.

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Characteristics of Japanese Patients with Complex Sleep Apnea Syndrome: A Retrospective Comparison with Obstructive Sleep Apnea Syndrome

Abstract: Objective The prevalence of complex sleep apnea syndrome (CompSAS)

Cited by 40 publications

References 20 publications

Rapid Eye Movement (REM) rebound on initial exposure to CPAP therapy: a systematic review and meta-analysis

Rapid Eye Movement (REM) rebound on initial exposure to CPAP therapy: a systematic review and meta-analysis

Complex sleep apnoea syndrome

Central Sleep Apnea

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