Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

Abstract

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.

Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes

“…Since sleep problems, such as OSA and EDS, have been associated with the current coronavirus disease 2019 (COVID-19) pandemic [ 69 , 70 ], post-COVID-19 fatigue should be ruled out as well. Also, treatment-emergent central sleep apnea should be considered as a cause of persistent sleepiness since it can develop during treatment of OSA with CPAP and is also associated with EDS [ 71 ].…”

Periodic breathing in patients with stable obstructive sleep apnea on long-term continuous positive airway pressure treatment: a retrospective study using CPAP remote monitoring data

“…We might have been unable to completely differentiate between TECSA and non-pathological CSA-CSB observed at sleep onset or in the rapid eye movement (REM) stage in elderly patients and others. Although there are various reports on the incidence of TECSA during the early phase of positive airway pressure (PAP) treatment, TECSA is self-limiting and resolves within 3 months in 90% or more of patients [ 30 ]. In a prospective study of patients with normal BNP levels, Westhoff et al reported that the incidence of TECSA was as low as 0.56% [ 31 ].…”