The current management of patients with syndromes associated with obstructive and central apnea

Over the past few decades, sleep-disordered breathing (SDB) has emerged as a critical public health problem. While the recognition of the impact of SDB on quality of life, morbidity and cardiovascular morbidity is increasing, our knowledge of the mechanism of SDB and its consequences remain only partial. Classification of SDB into two main syndromes of obstructive and central sleep apnea has been the standard of practice for the past 4 decades. This classification appears to ignore an increasingly recognized group of patients with SDB who manifest various combinations of both central and obstructive sleep apnea. This group includes patients with systolic heart failure, as well as less characterized group of patients who manifest central apnea when exposed to continuous positive airway pressure. Additionally, a newly recognized syndrome of SDB is associated with chronic opioids use. Treatment of these mixed SDB syndromes can be more complicated and expensive than the standard treatment of obstructive sleep apnea. Recognition of patients at risk for these syndromes and knowledge of treatment options are critical for providing care to these patients. In this article, we will discuss the available research and current state of knowledge regarding the overlap between central and obstructive sleep apnea. We will also contribute to the discussion regarding the classification process of SDB. Finally, we will attempt to develop a novel clinical approach to patients who manifest a mixed pattern of SDB.