Complex sleep apnea is correctly named. The challenges it presents are so vast that even researchers don’t always agree on simple things like what the condition actually includes. This disagreement makes it even more difficult to diagnose and treat. Here’s everything you need to know to get a proper diagnosis and treatment for complex sleep apnea.
What is complex sleep apnea syndrome?
Sleep apnea is classified under the larger umbrella of sleep disordered breathing, a condition that affects an estimated 90 million people in the U.S. There are three types of sleep apnea.
Obstructive sleep apnea (OSA) is the most common and occurs when a sleeper’s airway is blocked by the relaxing tissues of the tongue and throat. The next most common type of sleep apnea, central sleep apnea (CSA), affects fewer than two million people. In this type, the brain essentially “forgets” to breathe.
Complex sleep apnea (also sometimes referred to as complex sleep apnea syndrome) is a combination of the two. A patient with obstructive sleep apnea may appear to develop central sleep apnea during CPAP treatment. Essentially, patients have the obstruction of OSA and then develop breathing patterns seen in CSA.
When a patient is diagnosed initially with OSA and then develops symptoms of CSA during CPAP treatment, this is referred to as “treatment-emergent central apnea.” Not everyone who receives CPAP treatment will develop complex sleep apnea. In some cases, this form of sleep apnea can emerge in patients after tracheostomy, maxillomandibular advancement surgery, or use of a mandibular advancement device.
Regardless of when the condition appears, it’s important to recognize the signs early so that other treatment options can be explored.
How common is complex sleep apnea?
Because it is so challenging to identify and does not show up generally until CPAP or other sleep apnea treatment, it is hard to pinpoint the exact prevalence of complex sleep apnea. Some researchers put it at about 3% of overall sleep apnea cases. If there are 25 million sleep apnea cases in the U.S., that makes the form of sleep apnea rare, occurring in 750,000 sleepers.
Another study estimated worldwide prevalence to be between 0.56% to 18% of all types of sleep apnea.
What causes complex sleep apnea?
As this condition is rare and not well understood, it is difficult to pinpoint the exact causes. Some doctors believe it is a confluence of factors that include the blocked upper airway and an unstable central nervous system. Taken separately, these factors contribute to their respective types of sleep apnea. Together, they contribute to complex sleep apnea.
It seems that unstable sleep patterns also contribute to an uncertain or “malfunctioning” nervous system that provokes the central sleep apnea portion of this syndrome.
Other suspected causes include the following:
- Over or inadequate titration of the CPAP machine: The CPAP machine delivers too much or too little pressure
- Leaking CPAP mask: This can lead to too little pressure
- Weight gain: OSA can become complex sleep apnea with weight gain
- Narcotic use: Depressants reduce the activity in the central nervous system
Even with these potential causes, it still remains true that clinicians and researchers are not 100% sure of the exact cause of this form of sleep apnea.
There are clear risk factors for complex sleep apnea, including:
- Systolic heart failure
- Congestive heart failure
- AFIB
- Opioid use
- Cerebrovascular diseases
Age and gender may influence incidence rates too, as older men are more likely to suffer from this condition than any other demographic.
6 complex sleep apnea treatments
Treatment of complex sleep apnea must address both the obstructive and the central sleep apnea portions of the condition. Here are six treatment approaches to consider.
1. Manage weight
Obesity is a major risk factor for severe obstructive sleep apnea, a condition that nearly always requires patients to use a PAP machine.
Losing weight is strongly correlated with a decrease in apneic events and even the disappearance of sleep apnea altogether.
2. PAP machines
Many patients don’t know that they have options when it comes to PAP machines. CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), and VPAP (variable positive airway pressure) devices are three PAP devices to keep the airway open.
The most important part of these devices is to make sure they are properly titrated and the mask fits correctly. There is evidence that continued use of properly calibrated PAP machines results in the disappearance of symptoms.
3. Add oxygen
Some patients respond well to CPAP treatments when more oxygen is added to their pressurized air.
4. Participate in a follow-up study
When a CPAP machine is properly calibrated, returning to the sleep lab for a follow-up study is important. This helps your doctor determine if further treatment is necessary.
5. Adaptive Servo Ventilation (ASV)
This device is a fairly new treatment option that is getting positive results for multiple forms of sleep apnea. As with PAP machines, adaptive servo ventilation (ASV) delivers airway pressure, but the machine itself calculates the timing and the rate of flow based on the patient. As the patient’s breathing begins to stabilize, ASV offers less assistance (but is ready to jump back in if necessary). This individualizes the treatment and adapts to any changes that occur.
Initial studies indicate that ASV is more successful than CPAP and BiPAP machines in treating complex sleep apnea.
6. Prescription medication
In patients who develop complex sleep apnea while undergoing opioid therapy, the medication acetazolamide has been shown to help counteract the depressive effects on the central nervous system and stimulate respiratory function.
This condition can be carefully managed and treated so that it may resolve itself after a period of time. If this occurs, a sleep apnea dental device may be all you need to keep your airway open all night long.
AZ Dentist is your Phoenix sleep apnea dentist. We can work with your doctor to help treat your complex sleep apnea. Get in touch today!
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