From the Guidelines
Central sleep apnea symptoms include episodes of stopped breathing during sleep, excessive daytime sleepiness, difficulty staying asleep, morning headaches, difficulty concentrating, mood changes, and waking up with shortness of breath or gasping for air. These symptoms are critical to recognize as they can significantly impact morbidity, mortality, and quality of life if left untreated. Central sleep apnea occurs when the brain fails to send proper signals to the muscles that control breathing, rather than from a physical blockage, as noted in the updated practice parameters by the American Academy of Sleep Medicine (AASM) 1.
Key characteristics and risk factors of central sleep apnea include:
- Episodes of stopped breathing during sleep
- Excessive daytime sleepiness
- Difficulty staying asleep
- Morning headaches
- Difficulty concentrating
- Mood changes
- Waking up with shortness of breath or gasping for air
- Underlying heart disorders, such as congestive heart failure
- History of stroke
- Presence of brain tumors
- Opioid use
- High altitude
It's essential to distinguish central sleep apnea from obstructive sleep apnea, as the treatment approaches can differ significantly. People with central sleep apnea often don't snore, which is a common symptom of obstructive sleep apnea. The diagnosis of central sleep apnea typically involves a sleep study (polysomnography) to assess breathing patterns during sleep. Treatment should address the underlying cause and may include oxygen supplementation, adaptive servo-ventilation (ASV), or bilevel positive airway pressure (BiPAP) therapy, depending on the severity and cause of the condition, as recommended by the AASM 1. However, it's crucial to consider the latest guidelines and contraindications, such as the use of ASV in patients with heart failure and reduced ejection fraction, which has been associated with increased cardiovascular mortality 1.
From the Research
Symptoms of Central Sleep Apnea
- Fatigue, sleep fragmentation, inattention, daytime sleepiness, and reduced quality of life are common symptoms of central sleep apnea (CSA) 2
- Excessive daytime sleepiness, morning headaches, witnessed apneas, and nocturnal arrhythmias are also shared symptoms between CSA and obstructive sleep apnea (OSA) 3
- Difficulty concentrating, dry mouth/throat, headaches, and interrupted sleep are additional symptoms reported by individuals with CSA 4
Diagnosis and Treatment
- A systematic clinical approach should be used to identify and treat CSA, with consideration of the patient's underlying clinical conditions and causes of CSA 2, 3
- Adaptive servo-ventilation (ASV), continuous positive airway pressure (CPAP), bi-level PAP with back-up rate (BPAP-BUR), and transvenous phrenic nerve stimulation (TPNS) are alternative treatment options for CSA, with varying comparative efficacies 5
- The choice of treatment should be based on the individual patient's needs and characteristics, such as the severity of heart failure and the presence of hypoxemia 6
Patient-Centered Outcomes
- Fatigue is a distinct and bothersome symptom for individuals with CSA, and its impact on daily activities, functioning, work, and relationships should be considered in treatment decisions 4
- The effectiveness of treatment should be evaluated based on patient-centered outcomes, such as quality of life, quality of sleep, and longer-term survival 2