What is the treatment for central sleep apnea (CSA)?

From the Guidelines

Central sleep apnea (CSA) should not be treated with adaptive servo-ventilation due to associated harm.

Treatment Options for Central Sleep Apnea

• The treatment for CSA is not explicitly stated in the provided evidence, but it is clear that adaptive servo-ventilation is harmful and should be avoided 1.
• The evidence focuses on the importance of distinguishing between obstructive sleep apnea (OSA) and CSA, as they have different responses to treatment 1.
• Continuous positive airway pressure (CPAP) is recommended for OSA, but its use in CSA is not mentioned 1.
• The guideline recommends a formal sleep assessment to distinguish between OSA and CSA in patients with heart failure (HF) and suspicion of sleep-disordered breathing or excessive daytime sleepiness 1.
• The use of CPAP in patients with cardiovascular disease and OSA may be reasonable to improve sleep quality and daytime sleepiness, but its effectiveness in reducing cardiovascular events is limited 1.
• In patients with HF and CSA, the treatment options are not clearly stated, but avoiding adaptive servo-ventilation is recommended due to its association with harm 1.

From the Research

Treatment Options for Central Sleep Apnea (CSA)

The treatment for central sleep apnea (CSA) varies depending on the underlying cause and type of CSA. Some of the treatment options include:

• Positive Airway Pressure (PAP) therapy, such as continuous positive airway pressure (CPAP) or adaptive servo-ventilation (ASV) 2, 3, 4, 5
• Oxygen therapy 2, 3, 4, 5
• Acetazolamide 2, 5
• Theophylline 2, 5
• Zolpidem 2, 5
• Bilevel positive airway pressure-spontaneous timed mode (BPAP-ST) 2, 5
• Average volume assured pressure support (AVAPS) 2
• Non-invasive ventilation 6
• Phrenic nerve stimulation 4
• Pharmacologic therapy 4

Specific Treatment Recommendations

For specific types of CSA, the following treatment recommendations have been made:

• Primary Central Sleep Apnea (CSA): trial of PAP, acetazolamide, or zolpidem 2
• Central Sleep Apnea Due to Cheyne-Stokes Breathing Pattern in Congestive Heart Failure (CSR-CHF): PAP devices such as CPAP or ASV, oxygen therapy, acetazolamide, and theophylline 2, 3, 5
• Central Sleep Apnea due to High-Altitude Periodic Breathing: descent from altitude, supplemental oxygen, or acetazolamide 2
• Central Sleep Apnea due to Drug or Substance: trial of CPAP, ASV, or BPAP-ST 2
• Obesity Hypoventilation Syndrome: initial CPAP trial, followed by BPAP, BPAP-ST, or AVAPS if necessary 2
• Neuromuscular or Chest Wall Disease: early implementation of BPAP-ST or AVAPS 2

Important Considerations

It is essential to note that the treatment of CSA should be individualized and based on the underlying cause and type of CSA. Additionally, some treatments may have contraindications or require close clinical follow-up 4, 5.