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Complex sleep apnea syndrome (CompSAS) is a form of sleep apnea specifically identified by the presence or emergence of central apneas or hypopneas upon exposure to continuous positive airway pressure (CPAP) or a Bi-level positive airway pressure (BIPAP) device when obstructive events have disappeared. These patients have predominantly obstructive or mixed apneas during the diagnostic sleep study occurring at greater than or equal to 5 times per hour. With the use of CPAP or BiPAP they show a pattern of apneas and hypopneas that meets the definition of Central sleep apnea (CSA). As central hypopneas are rarely scored in clinical practice, the definition requires the occurrence of central apneas that make up more than 50% of all scored respiratory events, a threshold that could miss clinically significant non obstructive events.