Central sleep apnea: Treatment
- M Safwan Badr, MD
M Safwan Badr, MD
- Section Editor — Sleep Related Breathing Disorders
- Professor and Chief, Pulmonary Critical Care and Sleep Medicine
- Wayne State University School of Medicine
Central sleep apnea (CSA) is a disorder characterized by repetitive cessation or decrease of both airflow and ventilatory effort during sleep. It can be primary (ie, idiopathic CSA) or secondary. Examples of secondary CSA include CSA associated with Cheyne-Stokes breathing, a medical condition, a drug or substance, or high altitude periodic breathing . CSA associated with Cheyne-Stokes breathing is particularly common, especially among patients who have heart failure or have had a stroke. It is characterized by central apneas that occur during the decrescendo portion of the cyclic crescendo-decrescendo respiratory pattern. (See "Classification of sleep disorders", section on 'Sleep-related breathing disorders' and "Sleep disordered breathing in heart failure".)
CSA can alternatively be categorized as hyperventilation- or hypoventilation-related. Hyperventilation-related CSA encompasses most of the types of CSA mentioned above, with CSA associated with a drug or substance being a notable exception. Hypoventilation-related CSA occurs in disorders in which there is alveolar hypoventilation that is so severe that central apneas occur when the patient falls asleep because the wakefulness stimulus to breathe disappears. Central apneas tend to be a minor component of such disorders. Examples of contexts in which hypoventilation-related CSA may occur include central nervous system diseases, central nervous system suppressing drugs or substances, neuromuscular diseases, and severe abnormalities in pulmonary mechanics (eg, kyphoscoliosis). (See "Central sleep apnea: Pathogenesis", section on 'Central apnea due to hyperventilation' and "Central sleep apnea: Pathogenesis", section on 'Central apnea due to hypoventilation'.)
In this topic review, we present an approach to treating CSA and then we describe the evidence supporting each intervention. The definition, risk factors, clinical presentation, diagnosis, and pathogenesis of CSA are discussed separately. (See "Central sleep apnea: Risk factors, clinical presentation, and diagnosis" and "Central sleep apnea: Pathogenesis".)
Untreated CSA disrupts sleep; therefore, sequelae may include excessive daytime sleepiness, inattention, poor concentration, morning headaches, difficulty maintaining sleep (ie, awakenings), and increased risk for a motor vehicle crash or a workplace accident. These symptoms are likely to persist if the underlying condition also persists and the CSA is not treated. However, CSA may improve if the underlying condition also improves.
This section presents an approach to treating patients with CSA.
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- NATURAL HISTORY
- GENERAL APPROACH
- Choice of therapy
- TREATMENT MODALITIES
- Positive airway pressure
- - Continuous positive airway pressure
- - Adaptive servo-ventilation (ASV)
- - Bilevel positive airway pressure (BPAP)
- Supplemental oxygen during sleep
- Pharmacologic therapy
- SUMMARY AND RECOMMENDATIONS