Complex sleep apnea unmasked by the use of a mandibular advancement device

Kuźniar, Tomasz J.; Kovačević-Ristanović, Ružica; Freedom, Thomas

doi:10.1007/s11325-010-0459-8

Cited by 45 publications

(20 citation statements)

References 17 publications

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“…This patient redeveloped hypersomnolence and when restudied apneas of similar frequency, duration, and depth of desaturation reappeared but were now totally central in origin. KuŸniar et al9 reported on two patients with CompSAS who had similar phenomena when treated with an oral appliance. In an observation by Corcoran et al,10 a 38-year-old male who developed marked CSA 3 months after a maxillomandibular advancement surgery for moderate OSA was reported.…”

Section: Definitionmentioning

confidence: 91%

Complex sleep apnea syndrome

Wang¹,

Wang²,

Feng³

et al. 2013

PPA

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Complex sleep apnea syndrome (CompSAS) is a distinct form of sleep-disordered breathing characterized as central sleep apnea (CSA), and presents in obstructive sleep apnea (OSA) patients during initial treatment with a continuous positive airway pressure (CPAP) device. The mechanisms of why CompSAS occurs are not well understood, though we have a high loop gain theory that may help to explain it. It is still controversial regarding the prevalence and the clinical significance of CompSAS. Patients with CompSAS have clinical features similar to OSA, but they do exhibit breathing patterns like CSA. In most CompSAS cases, CSA events during initial CPAP titration are transient and they may disappear after continued CPAP use for 4~8 weeks or even longer. However, the poor initial experience of CompSAS patients with CPAP may not be avoided, and nonadherence with continued therapy may often result. Treatment options like adaptive servo-ventilation are available now that may rapidly resolve the disorder and relieve the symptoms of this disease with the potential of increasing early adherence to therapy. But these approaches are associated with more expensive and complicated devices. In this review, the definition, potential plausible mechanisms, clinical characteristics, and treatment approaches of CompSAS will be summarized.

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Section: Definitionmentioning

confidence: 91%

Complex sleep apnea syndrome

Wang¹,

Wang²,

Feng³

et al. 2013

PPA

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“…advancement devices for OSA treatment, [5][6][7][8][9] although the occurrence of this phenomenon seems to be rare. Our patient …”

Section: Discussionmentioning

confidence: 99%

Complex Sleep Apnea Associated with Use of Nasal Expiratory Positive Airway (nEPAP) Device

Chopra

Das

Ramar

et al. 2014

Journal of Clinical Sleep Medicine

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“…Recently, there have been arguments to label this form of sleep disordered breathing as CompSAS in the absence of a CPAP trial, since emerging central apnoeas were also reported after initiation of oral appliance [52], tracheostomy [53], maxillofacial surgery [54] and after surgical relief of nasal obstruction [55].…”

Section: Cpap-independent Compsasmentioning

confidence: 99%

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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Complex sleep apnea unmasked by the use of a mandibular advancement device

Cited by 45 publications

References 17 publications

Complex sleep apnea syndrome

Complex sleep apnea syndrome

Complex Sleep Apnea Associated with Use of Nasal Expiratory Positive Airway (nEPAP) Device

Complex sleep apnoea syndrome

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