Understanding Complex Sleep Apnoea
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Complex sleep apnoea, also known as treatment-emergent central sleep apnoea (TECSA), is a sleep disorder that combines features of both obstructive sleep apnoea (OSA) and central sleep apnoea (CSA) (1). It is essential to recognise and understand this condition to provide adequate treatment and improve sleep quality.
Symptoms
Symptoms of complex sleep apnoea are similar to those of obstructive and central sleep apnoea and may include:
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Loud snoring
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Episodes of breathing cessation during sleep observed by another person
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Abrupt awakenings with shortness of breath
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Difficulty staying asleep (insomnia)
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Excessive daytime sleepiness (hypersomnia)
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Attention problems
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Irritability or mood changes (3)
Diagnosis of complex sleep apnoea typically involves:
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The process begins with a thorough medical history and assessment of symptoms.
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An overnight sleep study called (polysomnography) to monitor breathing patterns is conducted in a sleep lab.
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Evaluation of any existing treatment, particularly use of PAP therapy.
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Complex sleep apnoea is diagnosed if central apnoeas develop or persist during PAP therapy despite the resolution of obstructive events.
Complex sleep apnoea occurs when a person who has been diagnosed with OSA develops CSA during treatment with CPAP therapy. In OSA the airway becomes partially or completely blocked during sleep, causing interrupted breathing. CSA, however, involves a failure of the brain's respiratory control centres to send the appropriate signals to the muscles that control breathing. the prevalence of complex sleep apnoea is estimated to be from 10- 20% (1-2).
Causes
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Response to Introduction of CPAP therapy: CPAP treatment for OSA can stabilize the airway but may affect carbon dioxide levels and breathing patterns, leading to the development of central apnoeas.
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Instability in Respiratory Control: Some individuals have heightened sensitivity in the brain's response to changes in blood gas levels (oxygen and carbon dioxide). This sensitivity can lead to irregular breathing patterns, as the brain overreacts to normal fluctuations in breathing.
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Heart Failure and Other Disorders: Conditions like heart failure can contribute to the development of CSA and, subsequently, complex sleep apnoea. Such conditions might alter the feedback mechanisms involved in respiration.
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Ventilatory Instability: Imbalances in the body's feedback control systems that regulate breathing can lead to varying patterns of apnoea, especially during changes in sleep stages or body positions.
Complex sleep apnoea is a nuanced condition that requires comprehensive management tailored to each individual’s needs. If you suspect complex sleep apnoea, it is essential to consult a healthcare professional for evaluation and to discuss the most appropriate treatment options.
By understanding complex sleep apnoea and its implications, patients and healthcare providers can work together to improve sleep quality and overall health. Keep in mind that ongoing research continues to enhance our understanding of this condition and its effective management strategies.
References
1. Randerath W, Baillieul S, Tamisier R. Central sleep apnoea: not just one phenotype. European Respiratory Review. 2024 Jan 31;33(171).
2. Pépin JL, Schwartz AR, Khayat R, Germany R, McKane S, Warde M, Ngo V, Baillieul S, Bailly S, Tamisier R. Multidimensional phenotyping to distinguish among central (CSA), obstructive (OSA) and co-existing central and obstructive sleep apnea (CSA-OSA) phenotypes in real-world data. Sleep Medicine. 2024 Dec 1;124:426-33.
3. Randerath W, Bassetti CL, Bonsignore MR, Farre R, Ferini-Strambi L, Grote L, Hedner J, Kohler M, Martinez-Garcia MA, Mihaicuta S, Montserrat J. Challenges and perspectives in obstructive sleep apnoea: report by an ad hoc working group of the Sleep Disordered Breathing Group of the European Respiratory Society and the European Sleep Research Society. European respiratory journal. 2018 Sep 1;52(3).
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