From the Guidelines
Central sleep apnea (CSA) is a serious sleep disorder characterized by repeated episodes of paused or shallow breathing during sleep, which can lead to fragmented sleep and decreased oxygen levels in the blood 1.
Definition and Causes
CSA is often associated with underlying medical conditions, such as heart failure, opioid use, or neurological disorders 1.
- The condition can also be caused by poor ventilatory control, which may be present in individuals with Prader-Willi syndrome 1.
- Additionally, scoliosis or other spinal abnormalities can increase the risk of CSA, particularly in individuals with Prader-Willi syndrome 1.
Diagnosis and Treatment
Diagnosis of CSA typically involves overnight polysomnography to determine the underlying cause of the condition 1.
- Treatment for CSA usually involves addressing the underlying cause, such as heart failure or opioid use 1.
- In some cases, medication such as acetazolamide may be prescribed to help stimulate breathing, with a typical dose of 250-500 mg orally at bedtime 1.
- Patients with CSA may also benefit from using a positive airway pressure (PAP) device, such as a continuous PAP (CPAP) or adaptive servo-ventilation (ASV) device, to help regulate their breathing during sleep 1.
Management and Follow-up
In general, patients with CSA should be closely monitored and followed up regularly to assess the effectiveness of treatment and make any necessary adjustments 1.
- It is also important for patients to make lifestyle changes, such as losing weight, exercising regularly, and avoiding sedatives and opioids, to help manage their condition 1.
From the Research
Definition of Central Sleep Apnea (CSA)
- Central sleep apnea (CSA) is a disorder characterized by apneic episodes during sleep with no associated ventilatory effort 2, 3.
- It is not a single disease, but rather a final pathway in a large group of heterogeneous disorders 4.
- CSA can occur as a distinct clinical entity or as part of another clinical syndrome 5.
Causes and Classification of CSA
- The causes of CSA can be classified into four groups: neurologic disorders, periodic breathing, upper airway abnormalities, and idiopathic syndromes 4.
- Medical conditions most closely associated with CSA include heart failure, stroke, spinal cord injury, and opioid use, among others 5.
- CSA can be primary (idiopathic) or secondary in association with Cheyne-Stokes respiration, drug-induced, medical conditions such as chronic renal failure, or high-altitude periodic breathing 6.
Clinical Features and Diagnosis of CSA
- Clinical features of CSA result from the interaction between the underlying disorder and control of respiration 4.
- Patients with CSA may complain of insomnia and depression, but frank hypersomnolence is rarely encountered 2.
- Nocturnal polysomnography is the standard diagnostic method, including measurement of sleep and respiration 5, 3.
- The diagnosis of CSA can be determined by clinical assessment, pulmonary function testing, and overnight polysomnography 4.
Treatment and Management of CSA
- The treatment of CSA is not entirely satisfactory, and management involves specific treatment of the underlying condition and reducing the sequelae of recurrent apneas during sleep 4, 2.
- Therapeutic options include positive pressure therapy, pharmacologic therapy, and supplemental oxygen 5.
- Continuous positive airway pressure (CPAP) is the initial standard of care, although the utility of other modes of positive pressure therapy, as well as pharmacotherapy and device-based therapies, are currently being investigated 5.