Indian Journal of Sleep Medicine

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VOLUME 19 , ISSUE 1 ( January-March, 2024 ) > List of Articles


Central Sleep Apnea due to Positive Airway Pressure Mask Leakage

Pranav Ish, Vidushi Rathi, Rohit Kumar, Nitesh Gupta, Ganesh Narwade

Keywords : Case report, Central sleep apnea, Mask, Obstructive sleep apnea, Positive airway pressure

Citation Information : Ish P, Rathi V, Kumar R, Gupta N, Narwade G. Central Sleep Apnea due to Positive Airway Pressure Mask Leakage. Indian Sleep Med 2024; 19 (1):4-6.

DOI: 10.5005/jp-journals-10069-0125

License: CC BY-NC 4.0

Published Online: 28-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Complex sleep apnea is the term used for central sleep apnea (CSA) events that arise during positive airway pressure (PAP) titration in a patient undergoing polysomnography (PSG). Multiple mechanisms have been used to explain the same including hypocapnia, loss of central drive, circulatory delay, or arousals. However, PAP mask leakage is an easily correctable cause of CSA during titration studies. We hereby present a case of a middle-aged female who was diagnosed with severe obstructive sleep apnea (OSA), and developed central events during titration, which were easily corrected by readjusting the oronasal mask.

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  1. Behera D, Suri JC, Ish P, et al. Role of esophageal manometry in polysomnography of patients with chronic respiratory failure. Monaldi Arch Chest Dis 2021;91(4). DOI: 10.4081/monaldi.2021.1756.
  2. Gilmartin GS, Daly RW, Thomas RJ. Recognition and management of complex sleep-disordered breathing. Curr Opin Pulm Med 2005;11(6):485–493. DOI: 10.1097/01.mcp.0000183061.98665.b0.
  3. Morgenthaler TI, Kagramanov V, Hanak V, et al. Complex sleep apnea syndrome: Is it a unique clinical syndrome? Sleep 2006;29(9): 1203–1209. DOI: 10.1093/sleep/29.9.1203.
  4. American Academy of Sleep Medicine. International Classification of Sleep Disorders – Third Edition (ICSD-3). Chicago: American Academy of Sleep Medicine; 2014. Available at: Accessed on: 25 December 2023.
  5. Wang J, Wang Y, Feng J, et al. Complex sleep apnea syndrome. Patient Prefer Adherence 2013;7:633–641. DOI: 10.2147/PPA.S46626.
  6. Liu D, Armitstead J, Benjafield A, et al. Trajectories of emergent central sleep apnea during CPAP therapy. Chest 2017;152(4):751–760. DOI: 10.1016/j.chest.2017.06.010.
  7. Younes M, Ostrowski M, Thompson W, et al. Chemical control stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2001;163(5):1181. DOI: 10.1164/ajrccm.163.5.2007013.
  8. Johnson KG, Johnson DC. Bilevel positive airway pressure worsens central apneas during sleep. Chest 2005;128(4):2141–1250. DOI: 10.1378/chest.128.4.2141.
  9. Chowdhuri S, Shanidze I, Pierchala L, et al. Effect of episodic hypoxia on the susceptibility to hypocapnic central apnea during NREM sleep. J Appl Physiol (1985) 2010;108(2):369. DOI: 10.1152/japplphysiol.00308.2009.
  10. Salloum A, Rowley JA, Mateika JH, et al. 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):189–193. DOI: 10.1164/rccm.200810-1658OC.
  11. Montesi SB, Bakker JP, Macdonald M, et al. Air leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med 2013;9(11):1187–1191. DOI: 10.5664/jcsm.3166.
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