Palman A D
Sechenov First Moscow State Medical University, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(4. Vyp. 2):60-66. doi: 10.17116/jnevro20171174260-66.
Complex sleep apnea syndrome (Comp-SAS) is the term used to describe a specific form of sleep disordered breathing characterized by the arise of central sleep apnea in patient with previous obstructive sleep apnea syndrome (OSAS) treated with continuous positive airway pressure devices (CPAP). The mechanisms of its occurrence are not well understood, but partly it seems to be a consequence of increased carbon dioxide elimination under positive airway pressure treatment and related improvement of pulmonary ventilation. The prevalence of Comp-SAS ranges from 5% to 20% of OSAS patient getting CPAP therapy with no significant predictors in comparison with simple obstructive sleep apnea, but more likely to happened in older males with more severe OSAS and accompanying cardiovascular pathology such as ischemic heart disease, atrial fibrillation and heart failure. In most cases of Comp-SAS, central apnea events are transient and disappear after continuous CPAP therapy use for 1 to 2 months. Novel treatment options like adaptive servo-ventilation or BiPAP-ST are available for such non-responders to CPAP but contra-indicated to patients with systolic heart failure. From the other hand, still not clear is it mandatory to treat all affected individuals with Comp-SAS if the disease is uncomplicated and patient is asymptomatic.
复杂睡眠呼吸暂停综合征（Comp-SAS）是用于描述一种特定形式的睡眠呼吸障碍的术语，其特征为在接受持续气道正压通气设备（CPAP）治疗的既往阻塞性睡眠呼吸暂停综合征（OSAS）患者中出现中枢性睡眠呼吸暂停。其发生机制尚不完全清楚，但部分原因似乎是气道正压通气治疗下二氧化碳清除增加以及肺通气相关改善的结果。Comp-SAS的患病率在接受CPAP治疗的OSAS患者中为5%至20%，与单纯阻塞性睡眠呼吸暂停相比，没有显著的预测因素，但更可能发生在患有更严重OSAS且伴有心血管病变（如缺血性心脏病、心房颤动和心力衰竭）的老年男性中。在大多数Comp-SAS病例中，中枢性呼吸暂停事件是短暂的，在持续使用CPAP治疗1至2个月后消失。对于CPAP治疗无反应者，可采用适应性伺服通气或双水平气道正压通气-备用频率（BiPAP-ST）等新的治疗选择，但收缩性心力衰竭患者禁用。另一方面，如果疾病不复杂且患者无症状，是否必须治疗所有患有Comp-SAS的个体仍不清楚。
