mixed sleep apnea

Mixed sleep apnea, also known as complex sleep apnea, is a form of sleep disordered breathing that combines both obstructive and central sleep apneas.

Characteristics of Mixed Sleep Apnea

• Combination of Obstructive and Central Events: Mixed sleep apnea is characterized by a combination of both obstructive events (where the airway is blocked) and central events (where the brain doesn't send the signal to breathe).
• Recurring Central Apneas: This form of sleep apnea is marked by recurring central apneas, which are episodes where the person stops breathing due to a lack of respiratory effort from the brain.
• Mixed Apneas: Mixed apneas, as described in [5], are characterized by absent respiratory effort and airflow in the first section of the event and respiratory effort without airflow in the second part.

Symptoms

The symptoms of mixed sleep apnea can include:

• Excessive daytime fatigue or drowsiness
• Perceived poor sleep quality
• Frequent nighttime waking
• Observed episodes of not breathing during sleep
• Sudden awakenings with shortness of breath

Causes and Diagnosis

Mixed sleep apnea can occur when someone who previously had obstructive sleep apnea develops central sleep apnea due to treatment with CPAP, as mentioned in [3]. The diagnosis of mixed sleep apnea involves a combination of clinical evaluation, polysomnography (PSG), and other diagnostic tests.

References

• [1] Complex sleep apnea occurs when someone who previously had obstructive sleep apnea develops central sleep apnea due to treatment with CPAP.
• [2] What Are the Symptoms of Complex Sleep Apnea?
• [4] by MT Khan · 2014 · Cited by 45 — Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour) persist or emerge
• [5] by S Herkenrath · 2019 · Cited by 4 — Mixed apneas (MA) are characterized by absent respiratory effort and airflow in the first section of the event and respiratory effort without airflow in the ...
• [6] by S Apnea · Cited by 13 — There's also a mixed/complex type of sleep apnea. This form has a combination of both obstructive events and central events. Diagnosis and Tests ...

Mixed sleep apnea, also known as complex sleep apnea, is a type of sleep disorder that combines both obstructive and central sleep apnea symptoms.

Common signs and symptoms of mixed sleep apnea:

• Episodes of not breathing during sleep: People with mixed sleep apnea may experience episodes where they stop breathing for short periods, which can be reported by another person.
• Sudden awakenings with shortness of breath: Sufferers may wake up suddenly with a feeling of shortness of breath or difficulty catching their breath.
• Insomnia: Mixed sleep apnea can cause people to have trouble staying asleep throughout the night, leading to insomnia and daytime fatigue.
• Mood changes: Depression and anxiety are common symptoms of mixed sleep apnea, which can lead to mood swings and emotional instability.
• Disruptions in brain function: The condition can also disrupt normal brain function, leading to memory loss, trouble concentrating, and other cognitive problems.
• Unexplained fatigue: People with mixed sleep apnea may experience unexplained fatigue and tiredness, even after a full night's sleep.

Additional symptoms:

• Loud snoring
• Gasping for air during sleep
• Sudden awakenings with shortness of breath

It is essential to consult a healthcare professional if you or someone you know is experiencing these symptoms. They can provide an accurate diagnosis and recommend the best course of treatment.

References:

[1] - Complex sleep apnea occurs when someone who previously had obstructive sleep apnea develops central sleep apnea due to treatment with CPAP. (Source: Search result 3) [2] - Mood changes, depression and anxiety are common symptoms of sleep apnea. Disruptions in brain function. These can include memory loss, trouble concentrating. (Source: Search results 2 & 5) [3] - Observed episodes of not breathing during sleep. Sudden awakenings with shortness of breath. Not being able to stay asleep, known as insomnia. (Source: Search result 4) [4] - People with sleep apnea might also suffer from unexplained fatigue and mood swings, because their breathing interruptions continually wake them and prevent them from getting quality rest. (Source: Search result 7)

Diagnostic Tests for Mixed Sleep Apnea

Mixed sleep apnea, also known as complex sleep apnea syndrome (CSAS), is a type of sleep disorder that combines both central and obstructive sleep apneas. Diagnosing mixed sleep apnea requires a comprehensive evaluation of various physiological parameters during sleep.

• Polysomnography (PSG): This overnight sleep study is the gold standard for diagnosing sleep disorders, including mixed sleep apnea. PSG measures various physiological parameters such as brain waves, muscle activity, heart rate, and breathing patterns.
  • During a PSG test, you'll be hooked up to equipment that monitors your heart, lung, and brain activity, as well as your breathing patterns (2).
  • A polysomnogram is a sleep study in which medical sensors are used to monitor a person's breathing, heart rate, and the electrical activity of their muscles (3).
• Home Sleep Apnea Testing: While not as comprehensive as PSG, home sleep apnea testing can be used to confirm the diagnosis of mixed sleep apnea in symptomatic patients with a high likelihood of having the condition.
  • Home sleep apnea testing may be used to confirm the diagnosis in symptomatic patients with a high likelihood of having the condition (6).
• Other Diagnostic Tests: Additional tests, such as multiple sleep latency tests and arousal index analysis, may also be performed to further evaluate the severity of mixed sleep apnea.

References

1. Apr 6, 2023 — These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns.
2. Jul 14, 2023 — Polysomnography. During this sleep study, you're hooked up to equipment that monitors your heart, lung and brain activity and breathing patterns ...
3. Jun 6, 2024 — A polysomnogram is a sleep study in which medical sensors are used to monitor a person's breathing, heart rate, and the electrical activity of ...
4. Oct 3, 2024 — A PSG is necessary to accurately diagnose OSA and to assess treatment benefit.
5. The established test for OSA is in-laboratory polysomnography (PSG).
6. by CR Laratta · 2017 · Cited by 221 — Polysomnography is the gold standard for diagnosis; however, home sleep apnea testing may be used to confirm the diagnosis in symptomatic patients with a high ...
7. Overnight PSG is the conventional diagnostic test for OSA.
8. Jun 26, 2023 — Obstructive sleep apnea is diagnosed based on the results of an overnight test that evaluates breathing during sleep.

Mixed sleep apnea, also known as complex sleep apnea syndrome (CompSAS), is a condition where patients experience both central and obstructive sleep apneas during treatment with continuous positive airway pressure (CPAP) or bilevel therapy. While CPAP is the standard therapy for stabilizing the airway and preventing repeated collapse, there are some medications that may help alleviate central sleep apnea symptoms.

Medications Used to Treat Central Sleep Apnea

• Triazolam, zolpidem, and clonazepam have been shown to reduce central apnea activity [10]. These benzodiazepines can help improve the quality of sleep by reducing the frequency of central apneas.
• Other medications like oxygen, adaptive servo ventilation (ASV), added dead space, carbon dioxide, and phrenic nerve stimulators may also be used to treat central sleep apnea [7].

Important Considerations

• It's essential to note that medication treatment should only be considered under the guidance of a healthcare professional. They can help determine the best course of treatment for individual patients.
• Medication therapy is often used in conjunction with other treatments, such as positive airway pressure devices or lifestyle modifications, to manage mixed sleep apnea.

References

[1] Complex Sleep Apnea Treatment. Most cases of complex sleep apnea resolve over time. Therefore, a doctor may recommend continuing CPAP therapy [1].

[6] In addition to positive airway pressure, adaptive ventilation and phrenic nerve stimulators, there are some medications that may help central sleep apnea [6].

[7] Several different treatments aimed at central sleep apnea include positive airway pressure, adaptive servo ventilation (ASV), oxygen, added dead space, carbon dioxide, and phrenic nerve stimulators [7].

The differential diagnosis of mixed sleep apnea involves identifying and distinguishing it from other conditions that may present with similar symptoms.

Mixed sleep apnea, also known as complex sleep apnea syndrome (CSAS), is a condition where both central and obstructive sleep apneas occur together. To diagnose CSAS, healthcare providers must rule out other potential causes of sleep disturbances.

Differential Diagnosis

The differential diagnosis for mixed sleep apnea includes:

• Obstructive Sleep Apnea (OSA): The most common form of sleep apnea, characterized by repeated episodes of complete or partial upper airway obstruction during sleep.
• Central Sleep Apnea (CSA): A condition where the brain fails to send proper signals to breathe during sleep, leading to pauses in breathing.
• Complex Apnea: A term used to describe a combination of central and obstructive sleep apneas.

Other Conditions

Mixed sleep apnea can also be confused with other conditions that affect sleep quality, such as:

• Sleep-Related Hypopnea Syndrome (SRHS): A condition characterized by repeated episodes of partial upper airway obstruction during sleep.
• Idiopathic Hypersomnia: A rare sleep disorder where individuals experience excessive daytime sleepiness and prolonged nighttime sleep periods.

Risk Factors

Certain risk factors can increase the likelihood of mixed sleep apnea, including:

• Congestive Heart Failure
• Hypothyroid Disease
• Kidney Failure
• Neurological Diseases, such as Parkinson's disease

To accurately diagnose mixed sleep apnea, healthcare providers must consider these differential diagnoses and risk factors. A comprehensive evaluation, including polysomnography (PSG) and other diagnostic tests, may be necessary to determine the underlying cause of sleep disturbances.

References:

[4] Central sleep apnea can result from other conditions, such as heart failure and stroke. [7] Congestive heart failure is a risk factor for central sleep apnea. [9] In this article, we will first review the differential diagnosis of the various forms of complex apnea (or CPAP refractoriness), then summarize the possible causes.