What causes complex sleep apnea?

Updated: Aug 25, 2020
  • Author: Kendra Becker, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Central sleep apnea may emerge during titration of CPAP in patients previously diagnosed with obstructive sleep apnea. This syndrome, termed complex sleep apnea, has become a controversial topic in the sleep literature [9] and has been raised as a possible type of difficult-to-treat obstructive sleep apnea. As many as 6.5% of patients with obstructive sleep apnea may develop emergent or persistent central sleep apnea with CPAP treatment. CPAP emergent central sleep apnea is generally transitory and is eliminated after eight weeks of CPAP therapy. Persistent CPAP-related central sleep apnea has been observed in approximately 1.5% of treated patients. [10] Similarly, complex sleep apnea can occur following a tracheostomy for obstructive sleep apnea. Central apneas have been found initially after a tracheostomy, but after an extended period, central sleep apnea decreased on repeat PSG. [11]

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