Central sleep apnea due to high-altitude periodic breathing

Hrayr P Attarian MD (Dr. Attarian, Director at Northwestern University Sleep Fellowship at Northwestern University, has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released March 17, 1999; last updated March 20, 2016; expires March 20, 2019

In this article, the author explains the basics of central sleep apnea due to high-altitude periodic breathing. Included are updates on the association of heart rate variability and sympathetic tone with elements of high-altitude periodic breathing, as well as associations between high-altitude periodic breathing and behavioral awakenings.

Overview

In this article, the author explains the basics of central sleep apnea due to high-altitude periodic breathing. Included are updates on the new American Academy of Sleep Medicine diagnostic criteria, sex differences in adaptation to high altitude, development of central sleep apnea due to high-altitude periodic breathing, and the use of oxygen in prevention of the condition.

Key points

 

• Central sleep apnea due to high-altitude periodic breathing affects about a quarter of people who ascend to 2500 meters and almost 100% of those who ascend to 4000 meters or higher.

 

• It is characterized by central apneas, periodic breathing, insomnia, and sleep fragmentation.

 

• There are a variety of medications that may be beneficial, including sedative hypnotics, acetazolamide, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs).

 

• Women are more resistant to the effects of high altitude than men.

 

• Pregnant women at high altitudes tend to have increased neonatal complications and high risk of low birthweight in newborns.

Historical note and terminology

High-altitude insomnia and high-altitude periodic breathing are no longer diagnostic categories in the 2014 International Classification of Sleep Disorders, 3rd edition (American Academy of Sleep Medicine 2014). The current nomenclature is central sleep apnea due to high-altitude periodic breathing, which is characterized by cyclic periods of central apnea and hypopnea, usually accompanied by frequent awakenings, poor quality sleep, sense of suffocation, and fatigue at high altitudes.

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