Central sleep apnea due to high-altitude periodic breathing

Ali Karaki MD (

Dr. Karaki of Lebanese American University Medical Center has no relevant financial relationships to disclose.

Hrayr P Attarian MD (

Dr. Attarian, Director of the Northwestern University Sleep Disorders Program, received honorariums from Clearview and GLG for consulting work, honorariums from Pre Med for speaking engagements, and royalties from Flo for authorship.

Antonio Culebras MD, editor. (

Dr. Culebras of SUNY Upstate Medical University at Syracuse received an honorariums from Jazz Pharmaceuticals for a speaking engagements.

Originally released March 17, 1999; last updated November 22, 2020; expires November 22, 2023


In this article, the authors explain the basics of central sleep apnea due to high-altitude periodic breathing. Included are updates related to sleep timing, oxygen saturation and pulse oxymetry measurements at high-altitude.

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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