# A Case of De Novo Positional Complex Sleep Apnea Syndrome (CompSAS)

## TL;DR

A 78-year-old woman developed complex sleep apnea after a car accident, and her condition improved with positional therapy and oxygen.

## Contribution

This case highlights the potential benefit of positional therapy in managing positional central sleep apnea.

## Key findings

- The patient showed significant improvement in CSA with positional therapy and oxygen.
- Adaptive servo ventilation and BiPAP-ST provided no significant benefit.
- Positional therapy reduced CSA events in non-supine positions.

## Abstract

Obstructive sleep apnea (OSA) is well known to often improve with non-supine positioning as opposed to supine positioning. Emerging research supports a role for sleep position management in patients with central sleep apnea (CSA) as well. We report a case of de novo complex sleep apnea syndrome (CompSAS) in a 78-year-old female, who presented after a car accident due to unclear syncope. Diagnostic polysomnography (PSG) showed moderate OSA. A CompSAS developed under automatic positive airway pressure (APAP), while 4 years of downloaded data showed good adherence. No significant benefit was reported under adaptive servo ventilation (ASV) and BiPAP-ST, while a reduction in CSA in the non-supine position was noticed. Oxygen and sleep positional therapy (SPT) were considered, resulting in a significant improvement in CSA and sleep quality. Further research on the prevalence of positional CSA is needed.