Complex sleep apnea occuring after intracerebral haemorrhage with treatment by adaptive servoventilation in two patients: a case report

Complex sleep apnea syndrome is not well characterized. It is supposed that complex sleep apnea syndrome is more similar to central sleep apnea syndrome than to obstructive sleep apnea. CPAP can eliminate obstructive events in obstructive sleep apnea, but often leads to accumulation of problematic central apneas instead.

Central sleep apnea is referred to as instability of the breathing control system. Alveolar hypoventilation disorders, heart failure, neurological disorders and idiopathic forms of CSA are suggested as reasons. No literature seems to exist concerning new-onset of complex sleep apnea after cerebral surgery of subarachachnoidal hemorrhage in patients without further previous medical history.

We report a 33-yr-old female, who presented with a history of an aneurysma of the left arteria communicans posterior with a rupture and neurosurgical procedure in 1/2006. Afterwards, she developed excessive daytime sleepiness, which led to the diagnosis of a complex sleep apnea syndrome (AHI 29.23/h, OAHI 18/h, CAHI 11/h). Treatment with nCPAP reduced the obstructive pattern slightly, but increased central apnea. This led to the decision of treatment with AutoSetCS Resmed™ and a normalized breathing pattern (AHI 0,9/h).

Second we report a 65-year old man, who suffered a severe trauma from a car accident including intracerebral haemorrhage of the right parietal lobe in 1/2006. Despite only minor clinical manifestations, a complex sleep apnoea syndrome (AHI 39.21/h, OAHI 0.7/h, CAHI 35/h, average oxygen saturation under 90% of 67%, minimal oxygen saturation 78%) was diagnosed. An initial CPAP trial led to an increase of central events to a total of 45 (with 27 mixed apnoeas in addition) and an RDI/7hrs of 10. Therefore, the device was changed to AutoSetCS Resmed™, which led to an AHI 0.6/h.

Conclusion: Higher awareness is needed even in young patients with neurosurgical procedure with regard to sleep-associated breathing disorders.