Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0016
S. Mashaqi, R. Mehra
The focus of this chapter is central sleep apnea with Cheyne-Stokes breathing (CSA-CSB), a hypocapnic central sleep apnea commonly observed in patients with congestive heart failure (HF). The pathophysiologic aspects of CSA-CSB are discussed, including ventilatory responsiveness and concepts of loop gain, apneic threshold, and narrowing of the carbon dioxide delta gap serving as a predisposing factor. Complexities of the clinical approach are reviewed in terms of clinically contextualizing the findings from a large randomized controlled trial demonstrating increased cardiovascular-specific mortality in patients randomized to adaptive servo ventilation versus controls in those with central-predominant sleep apnea and reduced ejection fraction HF. Potential mechanistic explanations for these findings are reviewed and placed into context with available post hoc analyses from this trial. Treatment options are discussed, including the role of other positive airway pressure (PAP) modalities, supplemental oxygen, relevant medications, and innovative non-PAP therapies such as transvenous phrenic nerve stimulation.
{"title":"To Treat or Not to Treat","authors":"S. Mashaqi, R. Mehra","doi":"10.1093/MED/9780190671099.003.0016","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0016","url":null,"abstract":"The focus of this chapter is central sleep apnea with Cheyne-Stokes breathing (CSA-CSB), a hypocapnic central sleep apnea commonly observed in patients with congestive heart failure (HF). The pathophysiologic aspects of CSA-CSB are discussed, including ventilatory responsiveness and concepts of loop gain, apneic threshold, and narrowing of the carbon dioxide delta gap serving as a predisposing factor. Complexities of the clinical approach are reviewed in terms of clinically contextualizing the findings from a large randomized controlled trial demonstrating increased cardiovascular-specific mortality in patients randomized to adaptive servo ventilation versus controls in those with central-predominant sleep apnea and reduced ejection fraction HF. Potential mechanistic explanations for these findings are reviewed and placed into context with available post hoc analyses from this trial. Treatment options are discussed, including the role of other positive airway pressure (PAP) modalities, supplemental oxygen, relevant medications, and innovative non-PAP therapies such as transvenous phrenic nerve stimulation.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85600745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0027
E. Bremer, L. Trotti
Idiopathic hypersomnia is a chronic disorder of excessive daytime sleepiness that is characterized by unrefreshing sleep despite normal or long sleep times and sleep inertia. Both symptoms can interfere with normal functioning. The diagnosis requires confirmation of sleepiness or increased sleep propensity via actigraphy, polysomnography, and/or multiple sleep latency test. Clinical evaluation, sleep diagnostics, and laboratory testing must exclude other disorders of excessive sleepiness. Treatment options are limited by the lack of approval by the U.S. Food and Drug Administration of any medications for this indication, as well as the relatively small number of clinical trials including patients with this disorder. Off-label treatments may be used and new treatments are being researched.
{"title":"My Husband Tells Me I’m Lazy","authors":"E. Bremer, L. Trotti","doi":"10.1093/MED/9780190671099.003.0027","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0027","url":null,"abstract":"Idiopathic hypersomnia is a chronic disorder of excessive daytime sleepiness that is characterized by unrefreshing sleep despite normal or long sleep times and sleep inertia. Both symptoms can interfere with normal functioning. The diagnosis requires confirmation of sleepiness or increased sleep propensity via actigraphy, polysomnography, and/or multiple sleep latency test. Clinical evaluation, sleep diagnostics, and laboratory testing must exclude other disorders of excessive sleepiness. Treatment options are limited by the lack of approval by the U.S. Food and Drug Administration of any medications for this indication, as well as the relatively small number of clinical trials including patients with this disorder. Off-label treatments may be used and new treatments are being researched.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91033217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0014
E. Polk, Subhra Chakrabarti, R. Mehra, Sushruta Cerejo
Obstructive sleep apnea (OSA) has been associated with significant decrements in quality of life, including daytime sleepiness, drowsy driving, and adverse health effects. Treatment of OSA with continuous positive airway pressure (CPAP) improves sleepiness symptoms, and some data support improvement in cardiometabolic outcomes. CPAP adherence, however, remains suboptimal, thereby hampering the symptom-based and health benefits that could be fully realized. Many strategies have been developed to increase PAP adherence, including behavioral interventions and an approach known as the PAP-NAP study, an intervention that focuses on improving the patient’s acceptance of PAP therapy by using regimented acclimation and desensitization techniques.
{"title":"CPAP, What’s Not to Love?","authors":"E. Polk, Subhra Chakrabarti, R. Mehra, Sushruta Cerejo","doi":"10.1093/MED/9780190671099.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0014","url":null,"abstract":"Obstructive sleep apnea (OSA) has been associated with significant decrements in quality of life, including daytime sleepiness, drowsy driving, and adverse health effects. Treatment of OSA with continuous positive airway pressure (CPAP) improves sleepiness symptoms, and some data support improvement in cardiometabolic outcomes. CPAP adherence, however, remains suboptimal, thereby hampering the symptom-based and health benefits that could be fully realized. Many strategies have been developed to increase PAP adherence, including behavioral interventions and an approach known as the PAP-NAP study, an intervention that focuses on improving the patient’s acceptance of PAP therapy by using regimented acclimation and desensitization techniques.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89375323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0028
M. Irfan, Michael J Howell
Sexual behavior in sleep has only recently been recognized as a variant of non–rapid-eye-movement (NREM) arousal parasomnias. This chapter discusses a case of sexsomnia precipitated by obstructive sleep apnea, the ensuing impact on the subject and his bed partner, and evaluation and management strategies. Sexsomnia is suspected to be highly underreported and carries significant physical, psychosocial, and forensic ramifications. Polysomnography with expanded electroencephalography can help identify concurrent sleep disorders and exclude other etiologies such as epilepsy. Treatment of comorbid sleep disorders such as obstructive sleep apnea and sleep deprivation is highly effective in controlling the abnormal sexual behavior. There is a pressing need for research and expansion of current understanding to develop a standardized approach to evaluation and management of sexsomnia.
{"title":"Unwanted Overtures by Night, Remorse by Day","authors":"M. Irfan, Michael J Howell","doi":"10.1093/MED/9780190671099.003.0028","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0028","url":null,"abstract":"Sexual behavior in sleep has only recently been recognized as a variant of non–rapid-eye-movement (NREM) arousal parasomnias. This chapter discusses a case of sexsomnia precipitated by obstructive sleep apnea, the ensuing impact on the subject and his bed partner, and evaluation and management strategies. Sexsomnia is suspected to be highly underreported and carries significant physical, psychosocial, and forensic ramifications. Polysomnography with expanded electroencephalography can help identify concurrent sleep disorders and exclude other etiologies such as epilepsy. Treatment of comorbid sleep disorders such as obstructive sleep apnea and sleep deprivation is highly effective in controlling the abnormal sexual behavior. There is a pressing need for research and expansion of current understanding to develop a standardized approach to evaluation and management of sexsomnia.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89453960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/med/9780190671099.003.0022
M. Alattar
This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.
{"title":"Tormented Sunrises","authors":"M. Alattar","doi":"10.1093/med/9780190671099.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780190671099.003.0022","url":null,"abstract":"This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80807342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0051
Frank M. Ralls, M. Grigg-Damberger
This chapter discusses the relationship between a commonly misdiagnosed parasomnia and various precipitating factors. Expertise in differentiating a benign parasomnia from significant medical disorders in adults and children is important, as is the ability to correctly identify and modify predisposing and precipitating factors. The case presented in this chapter illustrates how making a premature decision based on a small piece of information delayed an important diagnosis and increased the risk of further morbidity. The peak prevalence of sleep terrors is 18 months of age, but they may be seen at any age during childhood. When recurrent sleep terrors recur or develop in adults, evaluation for other primary sleep disorders, including sleep apnea, restless legs, shift work, and sleep deprivation, is warranted, and polysomnography is usually indicated. Identifying and correcting precipitating factors may minimize the recurrence of sleep terrors. Treatment of sleep apnea may greatly reduce the frequency of night terrors and other parasomnias.
{"title":"Terror at Northfield","authors":"Frank M. Ralls, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0051","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0051","url":null,"abstract":"This chapter discusses the relationship between a commonly misdiagnosed parasomnia and various precipitating factors. Expertise in differentiating a benign parasomnia from significant medical disorders in adults and children is important, as is the ability to correctly identify and modify predisposing and precipitating factors. The case presented in this chapter illustrates how making a premature decision based on a small piece of information delayed an important diagnosis and increased the risk of further morbidity. The peak prevalence of sleep terrors is 18 months of age, but they may be seen at any age during childhood. When recurrent sleep terrors recur or develop in adults, evaluation for other primary sleep disorders, including sleep apnea, restless legs, shift work, and sleep deprivation, is warranted, and polysomnography is usually indicated. Identifying and correcting precipitating factors may minimize the recurrence of sleep terrors. Treatment of sleep apnea may greatly reduce the frequency of night terrors and other parasomnias.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"407 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76827908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0015
Roxanne Valentino, Sally Ibrahim
This chapter describes a case of alternating leg muscle activation (ALMA) followed by discussion of this condition and the related hypnagogic foot tremor (HFT). HFT and ALMA are benign sleep-related movements of unknown etiology, typically found incidentally on polysomnography. Both HFT and ALMA are characterized by bursts of tibialis anterior activity occurring in sequences with an inter-burst interval shorter than found in periodic limb movements in sleep. There is no specific treatment for HFT and ALMA. Rather, treatment should focus on the other comorbid sleep disorders such as obstructive sleep apnea, as HFT and ALMA motor activity associated with respiratory events may be responsive to positive airway pressure therapy. In this chapter the diagnostic criteria and clinical features are summarized, and polysomnographic tracings and video samples are provided.
{"title":"Figuring Out Fitful Feet","authors":"Roxanne Valentino, Sally Ibrahim","doi":"10.1093/MED/9780190671099.003.0015","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0015","url":null,"abstract":"This chapter describes a case of alternating leg muscle activation (ALMA) followed by discussion of this condition and the related hypnagogic foot tremor (HFT). HFT and ALMA are benign sleep-related movements of unknown etiology, typically found incidentally on polysomnography. Both HFT and ALMA are characterized by bursts of tibialis anterior activity occurring in sequences with an inter-burst interval shorter than found in periodic limb movements in sleep. There is no specific treatment for HFT and ALMA. Rather, treatment should focus on the other comorbid sleep disorders such as obstructive sleep apnea, as HFT and ALMA motor activity associated with respiratory events may be responsive to positive airway pressure therapy. In this chapter the diagnostic criteria and clinical features are summarized, and polysomnographic tracings and video samples are provided.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76390858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0052
H. Mar, N. Chaisson
The high prevalence of pulmonary arterial hypertension (PAH) in patients with obstructive sleep apnea (OSA) and the putative pathophysiologic connections have been extensively documented. Conversely, patients with established PAH are at risk for sleep-related ventilatory instability, including OSA, central sleep apnea, and nocturnal desaturations. This chapter reviews the prevalence and pathophysiologic interactions of these conditions, the interplay with associated disorders, and the effects of continuous positive airway pressure therapy on pulmonary hemodynamics. In patients with OSA, chronic effects of repetitive hypoxia as well as comorbidities, including chronic obstructive pulmonary disease and left-sided heart dysfunction, play a role in promoting pulmonary hypertension. Sleep disordered breathing, representing a spectrum of sleep-related breathing disorders inclusive of OSA, is highly prevalent among patients with established pulmonary hypertension. Obstructive events, central sleep apnea, and nocturnal hypoxia are within the spectrum of sleep-related breathing disorders in pulmonary hypertension. The mechanisms for these associations remain speculative.
{"title":"Pulmonary Arterial Hypertension","authors":"H. Mar, N. Chaisson","doi":"10.1093/MED/9780190671099.003.0052","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0052","url":null,"abstract":"The high prevalence of pulmonary arterial hypertension (PAH) in patients with obstructive sleep apnea (OSA) and the putative pathophysiologic connections have been extensively documented. Conversely, patients with established PAH are at risk for sleep-related ventilatory instability, including OSA, central sleep apnea, and nocturnal desaturations. This chapter reviews the prevalence and pathophysiologic interactions of these conditions, the interplay with associated disorders, and the effects of continuous positive airway pressure therapy on pulmonary hemodynamics. In patients with OSA, chronic effects of repetitive hypoxia as well as comorbidities, including chronic obstructive pulmonary disease and left-sided heart dysfunction, play a role in promoting pulmonary hypertension. Sleep disordered breathing, representing a spectrum of sleep-related breathing disorders inclusive of OSA, is highly prevalent among patients with established pulmonary hypertension. Obstructive events, central sleep apnea, and nocturnal hypoxia are within the spectrum of sleep-related breathing disorders in pulmonary hypertension. The mechanisms for these associations remain speculative.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80910898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0053
Frank M. Ralls, Elyssa Glassheim, M. Grigg-Damberger
After treatment, this elderly gentleman with apparent depression rapidly became cognitively impaired and began hallucinating, eventually ending up in the psychiatric ward. This case provides insight into the complexities that may arise in the clinical evaluation and pharmacologic management of often-evolving cognitive, behavioral, and sleep-related changes in elderly individuals. This case additionally emphasizes the importance of sleep in emotional and mental stability, as well as the importance of physicians being well versed in the adverse effects of prescribed and over-the-counter medications. Mirtazapine can induce restless legs syndrome and periodic limb movements in sleep, conditions that can fragment sleep and interfere with cognition. Use of pramipexole has been shown to cause compulsive and impulsive behaviors in patients with restless legs syndrome, Parkinson disease, and multiple system atrophy. Donepezil can cause hallucinations in patients, which can be difficult to distinguish from hallucinations caused by dementia or Charles Bonnet syndrome; in these cases, establishing a timeline is integral in discovering the etiology.
{"title":"My Father Went Down the Rabbit Hole","authors":"Frank M. Ralls, Elyssa Glassheim, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0053","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0053","url":null,"abstract":"After treatment, this elderly gentleman with apparent depression rapidly became cognitively impaired and began hallucinating, eventually ending up in the psychiatric ward. This case provides insight into the complexities that may arise in the clinical evaluation and pharmacologic management of often-evolving cognitive, behavioral, and sleep-related changes in elderly individuals. This case additionally emphasizes the importance of sleep in emotional and mental stability, as well as the importance of physicians being well versed in the adverse effects of prescribed and over-the-counter medications. Mirtazapine can induce restless legs syndrome and periodic limb movements in sleep, conditions that can fragment sleep and interfere with cognition. Use of pramipexole has been shown to cause compulsive and impulsive behaviors in patients with restless legs syndrome, Parkinson disease, and multiple system atrophy. Donepezil can cause hallucinations in patients, which can be difficult to distinguish from hallucinations caused by dementia or Charles Bonnet syndrome; in these cases, establishing a timeline is integral in discovering the etiology.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87136604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0037
A. Chua, L. Aboussouan
This chapter presents a case of treatment-emergent central sleep apnea (TECSA), which is also known as complex sleep apnea syndrome or continuous positive airway pressure (CPAP)–emergent central sleep apnea. In this disorder, central apnea events emerge in patients with obstructive sleep apnea (OSA) after initiation of CPAP treatment. This phenomenon has been identified in up to 20% of patients with OSA who undergo CPAP titration. Polysomnography in those with TECSA usually shows an elevated residual Apnea–Hypopnea Index and arousal index after PAP initiation and occurs primarily during non–rapid-eye-movement sleep. Several mechanisms that have been postulated will be reviewed. The phenomenon is usually self-limiting, and recommended management includes applying the lowest PAP pressure needed to achieve reasonable control and avoiding modalities that exacerbate hypocapnia.
{"title":"Help, I Can’t Breathe!","authors":"A. Chua, L. Aboussouan","doi":"10.1093/MED/9780190671099.003.0037","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0037","url":null,"abstract":"This chapter presents a case of treatment-emergent central sleep apnea (TECSA), which is also known as complex sleep apnea syndrome or continuous positive airway pressure (CPAP)–emergent central sleep apnea. In this disorder, central apnea events emerge in patients with obstructive sleep apnea (OSA) after initiation of CPAP treatment. This phenomenon has been identified in up to 20% of patients with OSA who undergo CPAP titration. Polysomnography in those with TECSA usually shows an elevated residual Apnea–Hypopnea Index and arousal index after PAP initiation and occurs primarily during non–rapid-eye-movement sleep. Several mechanisms that have been postulated will be reviewed. The phenomenon is usually self-limiting, and recommended management includes applying the lowest PAP pressure needed to achieve reasonable control and avoiding modalities that exacerbate hypocapnia.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87282347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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