Development of central sleep apnea after maxillofacial surgery for obstructive sleep apnea.

Central sleep apnea is a rarely reported complication of surgery for obstructive sleep apnea (OSA). We report the case of a 38-year-old male who developed marked central sleep apnea 3 months after a maxillomandibular advancement for moderate OSA, which spontaneously resolved on his 6-month postoperative polysomnogram. Five prior cases of this postoperative complication have been reported in nonobese individuals after tracheostomy for OSA. Additionally, a recent study demonstrated that patients with atmospheric pharyngeal closing pressures are susceptible to unstable ventilation. We hypothesize that latent high loop gain from chronic OSA, coupled with atmospheric pharyngeal closing pressures, predisposed our patient to develop unstable ventilation after an abrupt postoperative change in his ventilatory load. Our case supports delaying postoperative polysomnography > or = 6 months in individuals at high risk for this complication.