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Central sleep apnoea—a clinical review

Central sleep apnoea (CSA) is characterised by recurrent apnoeas during sleep with no associated respiratory effort. It mostly results from withdrawal of the wakefulness drive in sleep leaving ventilation under metabolic control. A detailed physiological understanding of the control of breathing in wakefulness and sleep is essential to the understanding of CSA. It encompasses a diverse group of conditions with differing aetiologies and pathophysiology. Likewise treatment varies according to underlying aetiology. Some of the conditions such as idiopathic (primary) CSA (ICSA) are relatively rare and benign. On the other hand Cheyne-Stokes breathing (CSB) pattern is quite common in patients with…

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 Central Sleep Apnea in Adults: An Interdisciplinary Approach to Diagnosis and Management—A Narrative Review

Central sleep apnea (CSA) is a heterogeneous group of sleep-related breathing disorders characterized by intermittent absence of respiratory effort during sleep. CSA results from impaired neurological signaling from the respiratory centers to the respiratory muscles, leading to airflow cessation for at least 10 s. Major causes include heart failure, opioid use, central neurological disorders, and altitude exposure.

 Central Sleep Apnea in Heart Failure: What Now?

Neurophysiologically, central sleep apnea (CSA) is due to a temporary cessation of respiratory rhythmogenesis in ponto-medullary respiratory networks. Central apneas occur in a number of disorders including a variety of cardiovascular diseases and medications such as opioids, and ticagrelor used in the treatment of acute coronary syndrome. Overnight, CSA results in arousals, desaturation and negative swings in intrathoracic pressure during hyperventilation with potential for long-term pathophysiological cardiovascular consequences.

Articles of Interest

Central Sleep Apnea

Central sleep apnea (CSA) is characterized by a lack of drive to breathe during sleep, resulting in repetitive periods of insufficient ventilation and compromised gas exchange. These nighttime breathing disturbances can lead to important comorbidity and increased risk of adverse cardiovascular outcomes. There are several manifestations of CSA, including high altitude-induced periodic breathing, idiopathic CSA, narcotic-induced central apnea, obesity hypoventilation syndrome, and Cheyne-Stokes breathing.

Central Sleep Apnea: Expert Insights & Treatment Priorities

The conversation addresses important clinical distinctions between post-arousal, transitional, and mixed apneas, challenging common assumptions about their significance and treatment approaches. The panel provides clarity on various CSA etiologies, including heart failure-related periodic breathing, medication-induced central apneas, treatment-emergent CSA, and neurological disorders.

Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

This systematic review updates the previously published practice parameters on the treatment of CSA in adults. The use of the GRADE methodology offers a systematic approach that minimizes bias with recommendations based on the balance between the benefits and harms of each treatment intervention. In this systematic review, RCTs generally resulted in higher quality evidence over observational studies.

Treatment-emergent central sleep apnea: a unique sleep-disordered breathing

Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea.

Understanding Central Sleep Apnea

Central sleep apnea is a disorder in which your breathing repeatedly stops and starts during sleep. Central sleep apnea occurs because your brain doesn't send proper signals to the muscles that control your breathing. This condition is different from obstructive sleep apnea, in which you can't breathe normally because of upper airway obstruction. Central sleep apnea is less common than obstructive sleep apnea.

Resources

Sleep Foundation

CSA is often tied to an underlying health condition. If left unaddressed, this disorder can fragment a person’s sleep and lead to daytime drowsiness, thinking problems, and a heightened risk of errors and accidents. Learn more about the various types of CSA, as well as how the condition is diagnosed and managed.

StatPearls

Central sleep apnea (CSA) is characterized by transient diminution or cessation of the respiratory rhythm generator located within the pontomedullary region of the brain. In general, CSA represents an array of sleep-disordered breathing (SDB) conditions due to the brief absence of ventilatory output during sleep.