International classification of sleep disorders 2 and american academy of sleep medicine practice parameters for central sleep apnea

Although current evidence suggests reasonable treatment of CSAS with PAP therapy, further long-term studies are required to address the effects on hospital admission rates, morbidity, and mortality. Also, additional studies comparing the relative cost-effectiveness, risks, and benefits of various treatment modalities are needed. More research on multimodality titration polysomnograms that use a different device when the previous one is unsuccessful may eventually help reduce testing time and health care costs. Complex sleep apnea, the persistence or worsening of central sleep disordered breathing events on PAP in a patient with predominantly obstructive sleep apnea, was not addressed separately in the ICSD-2 or AASM practice parameters, but is a condition that is being increasingly encountered in clinical practice. Research is urgently desired to determine the need for and efficacy of treatment options for complex sleep apnea, particularly in the long term. At present, there is a paucity of literature on pharmacologic treatments for CSAS, especially CSAS not caused by CHF. Further studies are needed to evaluate the long-term harms and benefits of these treatments as well as new therapies such as exercise therapy and novel ventilation devices.