J Rhinol.  2022 Mar;29(1):56-58. 10.18787/jr.2021.00386.

Development of Central Sleep Apnea After Sleep Surgery

Affiliations
  • 1Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 2Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

Abstract

Central sleep apnea (CSA) is defined as an absence of breathing without respiratory drive during sleep. It can occur after treatment of obstructive sleep apnea (OSA), a phenomenon known as treatment-emergent central sleep apnea (TECSA). We present a case of a 23-year-old male who developed CSA after pharyngeal and nasal surgery for severe OSA. High loop gain and increased ventilations from frequent arousal are likely explanations for our patient’s central apnea, which resolved with positive airway pressure therapy that possibly alleviated residual airway obstruction and ventilatory instability. This case suggests that effectiveness of treatment for OSA should be based on careful long-term observation with multiple follow-up polysomnography tests, especially in patients at high risk of TECSA.

Keyword

Central sleep apnea; Obstructive sleep apnea; Surgery

Figure

  • Fig. 1. Photographs of the patient’s oral cavity and oropharynx.


Reference

References

1. Eckert DJ, Jordan AS, Merchia P, Malhotra A. Central sleep apnea: pathophysiology and treatment. Chest. 2007; 131(2):595–607.
2. Orr JE, Malhotra A, Sands SA. Pathogenesis of central and complex sleep apnoea. Respirology. 2017; 22(1):43–52.
Article
3. Salloum A, Rowley JA, Mateika JH, Chowdhuri S, Omran Q, Badr MS. Increased propensity for central apnea in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure. Am J Respir Crit Care Med. 2010; 181(2):189–93.
Article
4. Javaheri S, Smith J, Chung E. The prevalence and natural history of complex sleep apnea. J Clin Sleep Med. 2009; 5(3):205–11.
Article
5. Kuźniar TJ, Morgenthaler TI. Treatment of complex sleep apnea syndrome. Chest. 2012; 142(4):1049–57.
Article
6. Guilleminault C, Cummiskey J. Progressive improvement of apnea index and ventilatory response to CO2 after tracheostomy in obstructive sleep apnea syndrome. Am Rev Respir Dis. 1982; 126(1):14–20.
7. Corcoran S, Mysliwiec V, Niven AS, Fallah D. Development of central sleep apnea after maxillofacial surgery for obstructive sleep apnea. J Clin Sleep Med. 2009; 5(2):151–3.
Article
8. Avidan AY. The development of central sleep apnea with an oral appliance. Sleep Med. 2006; 7(1):85–6.
Article
9. Kuźniar TJ, Kovačević-Ristanović R, Freedom T. Complex sleep apnea unmasked by the use of a mandibular advancement device. Sleep Breath. 2011; 15(2):249–52.
Article
10. Testani E, De Corso E, Losurdo A, Fiorita A, Vollono C, Marca GD, et al. Treatment-emergent central sleep apnoea after surgery for obstructive sleep apnoea. Acta Otorhinolaryngol Ital. 2018; 38(5):476–9.
Article
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