[Errors and risks in administration of nasal respiratory therapy of obstructive sleep apnea]

Over a period of 1 year we observed in our sleep laboratory in 502 patients with sleep related breathing disorders several side effects of positive airway pressure treatment, furthermore we observed in 5 patients unexpected dangerous complications due to the application of CPAP and BIPAP. We observed mask leakages which lead to insufficient positive airway pressure-therapy and an occurence of short central apnoeas during NREM sleep after arousal or wakefulness periods. Finally we observed in 5 patients during treatment with CPAP and BIPAP an unexpected appearance of long central apnoeas up to 110s and central hypoventilations up to 5 min accompanied by excessive hypoxaemia (SaO2 < 20%) and cardiac arrhythmias. We conclude that in the treatment of obstructive sleep apnoeas we have to expect in 1-2% complications of the positive airway pressure treatment itself. To avoid life endangered complications the first night application should be done only in conventional sleep laboratories.