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Mixed apnea has the polysomnographic characteristics of central and obstructive apnea in the same event (Figure 21.1). Mixed apnea is usually central-obstructive. Obstructive-central apnea is very rare, except as terminal events.

Figure 21.1.— Mixed (central-obstructive) apnea. Left-sided electroencephalographic seizure. The apnea is associated with tachycardia and desaturation.

The type of apnea does not have a strong correlation with the cause of the apnea nor with the location of the pathology. Neonates with myasthenia gravis may have central apnea if the diaphragmatic involvement predominates, or obstructive apnea if upper airway muscle involvement predominates. The apnea type offers a window to the pathophysiology of the apnea that, when analyzed in conjunction with other clinical and laboratory findings, contributes to the differentiation between neurological and nonneurological causes of apnea and among the different possible sites of neurological involvement.

 
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body movements normal respiratory pattern (all channels are moving in the same direction 40 seconds 30 seconds 20 seconds abdominal movements channel thoracic movements channel airflow channel heart channels tachycardia mixed (central-obstructive) apnea EEG channels seizure eye movements channels Pause pointer on figure (arrows) to show labels. Figure must be centered.