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Central sleep apnea: Risk factors, clinical presentation, and diagnosis

M Safwan Badr, MD
Section Editor
Ronald D Chervin, MD, MS
Deputy Editor
April F Eichler, MD, MPH


Central sleep apnea (CSA) is a disorder characterized by repetitive cessation or decrease of both airflow and ventilatory effort during sleep. The condition can be primary (ie, idiopathic CSA) or secondary. Secondary CSA can arise, for example, in association with Cheyne-Stokes breathing, a medical condition, a drug or substance, or high altitude periodic breathing [1]. 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; a notable exception is CSA associated with a drug or substance. 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'.)

The clinical presentation and diagnosis of hyperventilation-related CSA are reviewed here. Hypoventilation-related CSA is not discussed here because central apneas tend to be a minor component of the underlying condition and, therefore, the presentation and diagnosis are dictated by the underlying condition. The pathogenesis and treatment of CSA are discussed separately. (See "Central sleep apnea: Pathogenesis" and "Central sleep apnea: Treatment".)


CSA is common, although less prevalent in the general population than obstructive sleep apnea (OSA). In a population-based study that included 5804 community-dwelling adults aged 40 years and older, the overall prevalence of CSA on polysomnography was 0.9 percent [2]. Approximately half of the CSA cases were associated with Cheyne-Stokes breathing (0.4 percent overall). The median age of patients with CSA was 69 years. CSA was more common among patients with heart failure (4.8 percent) and in men compared with women (1.8 versus 0.2 percent).


The prevalence of symptomatic CSA (ie, CSA syndrome) appears to be higher among individuals who are elderly, male, or have certain comorbid conditions.

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Literature review current through: Nov 2017. | This topic last updated: Jul 28, 2016.
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