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Complex Apnea May Explain Sleepless Nights

Failure of continuous positive airway pressure to resolve apparent obstructive sleep apnea may result in complex sleep apnea syndrome according to researchers.//

Timothy Morgenthaler, M.D., of the Mayo Clinic, and colleagues, reported in the Sept. 1 issue of Sleep reports that complex sleep apnea syndrome may cause a patient to lose sleep from a combination of physical and neurologic causes.

According to the researchers poor sleepers with symptoms consistent with both the obstructive and central forms of sleep apnea constitute a poorly recognized class of patients requiring novel therapies.

A consensus panel of sleep experts from the Europe, United States, Asia and Australia recently recommended classification of sleep-related breathing disorders into three clinical entities which are obstructive sleep apnea or hypoapnea syndrome marked by physical causes of airway disruption, central apnea-hypoapnea syndrome, and the Cheyne-Stokes breathing syndrome are related to abnormalities in central nervous control of respiration. However Mayo investigators have found that some patients with sleep apnea don't fit neatly into any of those categories.

Dr. Morgenthaler said, "All of us in our sleep lab have observed for years that there are patients who appear to have obstructive sleep apnea, but the CPAP doesn't make them all that much better. They still have moderate to severe sleep apnea even with our best treatment and subjectively don't feel they're doing very well.

"When they're put on a CPAP machine, they start to look like central sleep apnea syndrome patients. This phenomenon has been observed for years, but this study is the first attempt to categorize these people," he said.

Dr. Morgenthaler and colleagues conducted a retrospective review of 223 consecutive patients referred to the Mayo Clinic Sleep Disorders Center for evaluation over one month, plus an additional 20 consecutive patients who had been diag
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