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Complex Sleep Apnea (CPAP Emergent Central Apneas), and Apnea Related to Narcotics and to Altitude

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Primary Care Sleep Medicine

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Abstract

Complex sleep is the persistence of or emergence of central apneas on CPAP, when a patient with obstructive sleep apnea is treated with CPAP. Its recognition by the primary care provider is important since it may affect the patient’s ability to comply with and improve from therapy. It may be more common in obstructive sleep apnea patients with cardiac disease, on narcotics or living at altitude, but it is also common in patients with none of these risk factors. Treatment strategies range from watchful waiting on CPAP alone, using CPAP with adaptive servo ventilation, adding in-line O2 with CPAP, adding dead space or in-line CO2 to CPAP, or combinations of these strategies.

Narcotic medication may cause central sleep apnea, worsen obstructive sleep apnea, and predispose patients to complex sleep apnea.

The tendency for the hypoxia of altitude to cause central apneas with periodic breathing may affect healthy mountaineers at high altitudes, and also affect obstructive sleep apnea patients traveling to or living at even moderate altitudes.

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Abbreviations

CPAP:

Continuous positive airway pressure

OSA:

Obstructive sleep apnea

CSA:

Central sleep apnea

REM:

Rapid eye movement

ASV:

Adaptive servo ventilation

EPAP:

Expiratory positive pressure

IPAP:

Inspiratory positive pressure

CAI:

Central apnea index

AHI:

Apnea–hypopnea index

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Authors and Affiliations

  1. Department of Medicine, St. Mary’s Hospital, Grand Junction, Colorado, 452.5 Whitetail Lane, Grand Junction, CO, USA

    David Patz M.D.

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  1. David Patz M.D.
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Correspondence to David Patz M.D. .

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Editors and Affiliations

  1. Sleep Disorders Center, Pueblo, Colorado, USA

    James F. Pagel

  2. Department of Population Health, New York University School of Medicine / Center for Healthful Behavior Change, New York, New York, USA

    S. R. Pandi-Perumal

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Patz, D. (2014). Complex Sleep Apnea (CPAP Emergent Central Apneas), and Apnea Related to Narcotics and to Altitude. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_13

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  • DOI: https://doi.org/10.1007/978-1-4939-1185-1_13

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