What are the causes of Central Sleep Apnea (CSA)?

From the Guidelines

Central sleep apnea is primarily caused by a disruption in the brain's signals to the muscles that control breathing during sleep, often resulting from underlying issues such as heart disorders, stroke, brain infections, or certain medications. This condition can be triggered by various factors, including:

• Heart disorders like congestive heart failure, as discussed in the updated adaptive servo-ventilation recommendations for the 2012 AASM guideline 1
• Stroke or brain infections that affect the brainstem
• High altitude exposure
• Certain medications, particularly opioid pain medications like morphine, oxycodone, and codeine, which can suppress respiratory drive and trigger central sleep apnea
• Medical conditions affecting the brainstem, such as Parkinson's disease or encephalitis

The treatment of central sleep apnea typically addresses the underlying cause, and may incorporate therapies like continuous positive airway pressure (CPAP), adaptive servo-ventilation (ASV), or supplemental oxygen, as noted in the 2016 study on updated adaptive servo-ventilation recommendations 1. In cases where medications are the cause, adjusting dosages or switching to alternatives may be necessary. It is essential to prioritize the treatment of underlying conditions to improve morbidity, mortality, and quality of life outcomes for patients with central sleep apnea.

From the Research

Causes of 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 2
• CSA can be caused by various factors, including unstable ventilatory control during sleep, withdrawal of the wakefulness drive in sleep, and metabolic control of ventilation 3
• Some of the conditions that can lead to CSA include:
  • Idiopathic (primary) CSA
  • Cheyne-Stokes breathing (CSB) pattern, often seen in patients with heart failure
  • Narcotic-induced central apnea
  • Obesity hypoventilation syndrome
  • High-altitude periodic breathing
  • Chronic opioid use
  • Heart failure
  • Atrial fibrillation
  • Cerebrovascular accidents
  • Tetraplegia
  • Chronic renal failure 2, 3, 4, 5
• The pathophysiology of CSA involves a complex interplay of factors, including the apnea threshold, chemosensitivity, and the loss of the wakefulness drive to breathe 6

Risk Factors for Central Sleep Apnea

• Risk factors for CSA include:
  • Gender
  • Age
  • Heart failure
  • Opioid use
  • Stroke
  • Other chronic medical conditions 5
• These risk factors can contribute to the development of CSA by affecting the ventilatory drive and the stability of breathing during sleep 2, 3, 4