Treatment of complex sleep apnea syndrome: A retrospective comparative review

Background and purpose: Some patients with obstructive sleep apnea syndrome (OSAS) develop problematic central apneas or Cheyne-Stokes pattern with acute application of continuous positive airway pressure (CPAP), herein called complex sleep apnea syndrome (CompSAS). This response makes it difficult to be certain that CPAP will be a successful treatment strategy. We sought to compare treatments between patients with CompSAS vs. OSAS and hypothesized that CompSAS patients would find CPAP less effective and have more problems with adherence than patients with OSAS. Patients and methods: We performed a retrospective review of patients studied in our sleep disorders center over 1 month. Results: There were 133 patients with OSAS (mean age=57.6±12.2 years; males=63.9%) and 34 with CompSAS (mean age=54.4±16 years; males=82.35%). CPAP was prescribed in 93.7 and 87.9% of OSAS and CompSAS patients, respectively (P=0.284), with no significant difference in required CPAP pressures (P=0.112). There was no difference in prescription frequency of alternative therapies. Mean time to the first follow-up was shorter in CompSAS patients (46.2±47.3 vs. 53.8±36.8 days; P=0.022). CPAP compliance in OSAS and CompSAS patients (5.1±1.6 vs. 6.1±1.5 h, P=0.156) and improvement in Epworth Sleepiness Scale (ESS) (-4.6±4.8 vs. -5.9±6.9, P=0.483) was similar. However, interface problems were more common in CompSAS patients, especially air hunger/dyspnea (0.8 vs. 8.8%) and inadvertent mask removal (2.6 vs. 17.7%) (all P<0.050). Conclusion: CompSAS patients have more CPAP interface problems and require more follow-up than OSAS patients but with intervention may have similar treatment results compared to patients with OSAS.