Complex Sleep Apnea Syndrome: When Multiple Types Occur Together

Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, is a condition that combines features of both obstructive and central sleep apnea. This condition typically develops when someone with obstructive sleep apnea begins CPAP therapy, only to experience central sleep apnea events that weren't present during their initial diagnosis.

Complex sleep apnea affects an estimated 15% of people diagnosed with obstructive sleep apnea who begin CPAP treatment.

How Complex Sleep Apnea Develops

Complex sleep apnea typically emerges during the treatment process rather than being diagnosed initially. A person is diagnosed with obstructive sleep apnea through a sleep study, but after starting CPAP therapy, new symptoms begin to appear.

Signs and Symptoms

Because complex sleep apnea often arises during CPAP treatment, many individuals are surprised to find that their symptoms don't improve despite using the device. Symptoms can include persistent daytime fatigue, shortness of breath during sleep, observed breathing pauses, restless sleep, and difficulty concentrating.

Treatment Options

Treating complex sleep apnea often involves more than just traditional CPAP. Specialized approaches include Adaptive Servo-Ventilation (ASV), Bilevel PAP with backup rate, CPAP optimization, and treating underlying conditions.

Diagnosis

A sleep specialist may suspect complex sleep apnea if someone diagnosed with OSA and compliant with CPAP therapy continues to experience apneas or symptoms. A repeat sleep study can help identify whether central apneas are occurring despite treatment.