Complex Sleep Apnea

Castriotta, Richard J.; Majid, Ruckshanda

doi:10.1016/j.jsmc.2013.07.006

Cited by 4 publications

(4 citation statements)

References 69 publications

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“…Several terms have been used for the emergence of CSA events with the use of CPAP, including ''CPAPpersistent CSA'' and ''complex CSA syndrome.'' 10,14 The rate of the emergence of CSA events in the CPAP-related data has been found to be 2 to 20%. [10][11][12] The emergence of clinically relevant CSA events after MMA surgery in our study was only 1.8%.…”

Section: Discussionmentioning

confidence: 99%

“…These have included overtitration of CPAP, activation of respiratory stretch receptors, and an increased loop gain of the ventilatory system after upper airway stabilization. 11,12,14 Case reports of other treatment modalities that did not include the use of positive airway pressure have been documented to cause the emergence of CSA. These have included MMA surgery, 9 mandibular repositioning devices, 18 nasal surgery, 19 and tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

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Emergence of Central Sleep Apnea Events After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea

Goodday

Fay

2019

Journal of Oral and Maxillofacial Surgery

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Central sleep apnea (CSA) can develop after the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). No studies have identified whether treatment of OSA with maxillomandibular advancement surgery (MMA) can result in CSA. The purpose of our study was to determine the incidence and clinical significance of CSA emerging after MMA surgery to treat OSA.Patients and Methods: A retrospective review was conducted of all patients who had undergone MMA surgery for OSA at the Department of Oral and Maxillofacial Surgery at the QEII Health Sciences Centre (Halifax, NS, Canada) from 1996 through 2016. All patients with preoperative level 1 polysomnography and follow-up level 1 study results available at least 6 months postoperatively were included the present study. The pre-and postoperative central apnea index (CAI) results were compared.Results: A total of 113 patients (84 men and 29 women) with an average age of 44.0 years were included in the present study. In 35 patients (31.0%), the emergence of CSA events were recorded on postoperative polysomnograms. Only 2 of the 113 patients experienced the emergence of clinically significant postoperative CSA (CAI >5). In our patient cohort, gender (P = .085), patient age (P = .238), and preoperative (P = .716) and postoperative (P = .209) Apnea-Hypopnea Index (AHI) results correlated with the postoperative development of CSA events after MMA surgery. The mean AHI values had decreased from 41.4 to 8.7 in all patients treated with MMA in our study. Conclusions:The emergence of CSA events occurred in 31% of patients after OSA treatment with MMA surgery. The rate of clinically significant CSA events emerging after MMA surgery in our study was 1.8%. These findings help to support the use of MMA surgery for OSA as a reasonable treatment alternative for patients unable to tolerate CPAP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emergence of Central Sleep Apnea Events After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea

Goodday

Fay

2019

Journal of Oral and Maxillofacial Surgery

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“…In 2017, a European Respiratory Society Task Force document on nocturnal central breathing disturbances recognized this disorder as TECSA [2]. This term refers to the development of CSA during PAP therapy in the form of continuous positive airway pressure (CPAP), bi-level positive airway pressure (BPAP), or auto titrating PAP as treatment of obstructive sleep apnea (OSA) [3]. It can be defined as the appearance of repetitive CSA in patients with OSA after the initiation of PAP [3].…”

Section: Introductionmentioning

confidence: 99%

“…This term refers to the development of CSA during PAP therapy in the form of continuous positive airway pressure (CPAP), bi-level positive airway pressure (BPAP), or auto titrating PAP as treatment of obstructive sleep apnea (OSA) [3]. It can be defined as the appearance of repetitive CSA in patients with OSA after the initiation of PAP [3]. Figure 1 shows a histogram of a patient with OSA in which rapid titration of PAP during a split-night study resulted in treatment-emergent central apneas.…”

Section: Introductionmentioning

confidence: 99%

Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

BaHammam

2017

Sleep Vigilance

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Treatment-emergent central sleep apnea (TECSA) is a distinct form of sleep-disordered breathing characterized by the development of central sleep apnea during the initiation of positive airway pressure (PAP) therapy in patients with obstructive sleep apnea. The exact mechanisms of TECSA are not clearly known; however, several theories have been proposed. Usually, TECSA is transient and self-limited, and disappears after continued PAP use. Nevertheless, patients with persistent TECSA have lower adherence to PAP therapy and are more likely to terminate therapy. Close follow up is necessary to assure that the emergent central events disappear with continued therapy. In patients with persistent TECSA, more advanced algorithms such as adaptive servo-ventilation have been shown to be very effective. In this brief review, we summarize the definition, prevalence, predictors, pathophysiology, and treatment approaches of TECSA.

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Treatment-Emergent Central Sleep Apnea: Always Look for an Air Leak

Pirzada

BaHammam

2022

Teaching Pearls in Noninvasive Mechanical Ventilation

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Complex Sleep Apnea

Cited by 4 publications

References 69 publications

Emergence of Central Sleep Apnea Events After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea

Emergence of Central Sleep Apnea Events After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea

Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

Treatment-Emergent Central Sleep Apnea: Always Look for an Air Leak

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