Central sleep apnea

Antonio Culebras MD (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released October 1, 1993; last updated September 26, 2016; expires September 26, 2019

This article includes discussion of central sleep apnea, central apnea, nonobstructive apnea, central sleep apnea with central alveolar hypoventilation, mixed sleep apnea, and Cheyne-Stokes respiration (CSR-CSA). The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The author explains the basics of central sleep apnea. Central apnea is absence of airflow and ventilatory effort lasting 10 or more seconds during sleep. A central apnea index during an overnight polysomnography of 5 or more per hour of sleep is considered abnormal. A diagnosis of central sleep apnea is made when the apnea hypopnea index (AHI) is at least 5 with central apneas constituting 50% or more of the respiratory events. Central sleep apnea may occur in the setting of underlying hypo- or hyperventilation (ie, low-normal or elevated resting, awake partial pressure of arterial CO2). The International Classification of Sleep Disorders (ICSD-3rd edition) identifies 7 forms of central sleep apnea syndrome (CSAS): (1) primary central sleep apnea, (2) central sleep apnea with Cheyne-Stokes breathing pattern, (3) central sleep apnea due to medical condition without Cheyne-Stokes, (4) central sleep apnea due to high-altitude periodic breathing, (5) central sleep apnea due to a medication or substance, (6) primary sleep apnea of infancy, and (7) primary sleep apnea of prematurity.

In this article, the author presents the mechanisms, clinical scenarios, and treatment options for central sleep apnea.

Key points

 

• Central sleep apnea is caused by a brief, reversible failure of the normal ventilatory rhythm. Obstructive and central sleep apnea may coexist within the same individual.

 

• Treatment decisions are based on polysomnographic findings and clinical subtype of central sleep apnea.

 

• In patients with heart failure, the presence of Cheyne-Stokes respiration carried worse prognosis.

 

• There is no evidence that treatment of central sleep apnea reduces mortality.

 

• The use of auto-servo PAP in treatment of central sleep apnea in patients with heart failure was associated with increased mortality.

Historical note and terminology

The term "central sleep apnea" was coined by Gastaut and his collaborators in their report on the abnormal breathing patterns observed in a subtype of so-called "Pickwickian patients," morbidly obese subjects with somnolence and peripheral edema. In their population central sleep apnea was seen in association with obstructive and mixed apneas. Gastaut and colleagues defined central sleep apnea in adults as the absence of airflow and respiratory efforts for at least 10 seconds (Gastaut et al 1966). It was already apparent in 1964 and reemphasized in 1972 that central sleep apnea could be difficult to recognize in obese subjects, as many false positives were found with peripheral sensors.

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