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  • Updated 09.12.2023
  • Released 10.01.1993
  • Expires For CME 09.12.2026

Central sleep apnea



Central sleep apnea is a disease characterized by the absence or decrease of ventilatory effort resulting in the absence or decrease of airflow lasting 10 or more seconds during sleep. A diagnosis of central sleep apnea is made when central apneas or hypopneas constitute 50% or more of the respiratory events, and the central apnea index is five or more per hour of sleep using polysomnography (06).

The International Classification of Sleep Disorders (ICSD 3rd edition) identifies eight forms of central sleep apnea syndrome:

(1) Central sleep apnea with Cheyne-Stokes breathing (Cheyne-Stokes respiration)
(2) Central sleep apnea due to a medical disorder without Cheyne-Stokes respiration
(3) Central sleep apnea due to high altitude periodic breathing
(4) Central sleep apnea due to a medication or substance
(5) Treatment-emergent central sleep apnea
(6) Primary central sleep apnea
(7) Primary sleep apnea of infancy
(8) Primary sleep apnea of prematurity

In this article, the authors present the epidemiology, pathophysiology, diagnostic criteria, and treatment options for central sleep apnea in adults.

Key points

• Central sleep apnea is caused by a brief 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 subtypes of central sleep apnea.

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

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

• The use of adaptive servo-ventilation for central sleep apnea in heart failure with reduced left ventricular ejection fraction (ejection fraction less than 45%) is associated with increased mortality.

Historical note and terminology

Central sleep apnea was first described in 1966. Gastaut and his colleagues reported abnormal breathing patterns observed in an obese man with Pickwickian syndrome (57). He complained of worsening daytime somnolence related to weight gain. Polysomnography showed three abnormal breathing patterns: central, obstructive, and complex apneas. Since then, central sleep apnea in adults has been defined as the absence of airflow and respiratory efforts for at least 10 seconds (57).

John Hunter first reported an abnormal crescendo-decrescendo breathing pattern in the 18th century (05); John Cheyne reported the pattern in 1818 (31). In 1854, William Stokes asserted that this abnormal crescendo-decrescendo breathing pattern is related to a weak heart (149); the breathing pattern was named Cheyne-Stokes respiration.

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