Central sleep apnea

Central sleep apnea (CSA) is a sleep disorder characterized by the temporary cessation of breathing during sleep due to a lack of respiratory effort. This is caused by a failure of the brain to transmit the proper signals to the muscles responsible for controlling breathing. Central sleep apnea is distinct from obstructive sleep apnea (OSA), which results from a physical blockage of the airway. This article provides an overview of central sleep apnea, its symptoms, causes, diagnosis, and treatment options.

Etiology

Central sleep apnea can have various causes, including:

• Heart failure
• Stroke or brain tumor
• Chronic opioid use
• High altitude exposure
• Cheyne-Stokes respiration: a pattern of periodic breathing associated with heart failure and stroke
• Idiopathic central sleep apnea: CSA without an identifiable cause

Symptoms

The primary symptom of central sleep apnea is the cessation of breathing during sleep, often accompanied by:

Frequent awakenings or insomnia Snoring, although typically less prominent than in obstructive sleep apnea Gasping or choking during sleep Daytime sleepiness or fatigue Difficulty concentrating or memory problems Mood changes, such as irritability or depression

Diagnosis

Diagnosing central sleep apnea typically involves a comprehensive evaluation that may include:

Medical history and physical examination Sleep study (polysomnography): an overnight test that records brain activity, eye movements, heart rate, and other physiological parameters during sleep Assessment of potential underlying medical conditions or contributing factors, such as heart failure, stroke, or medication use

Treatment

Treatment for central sleep apnea focuses on addressing the underlying cause, if identifiable, and improving breathing during sleep. Some treatment options include:

Positive airway pressure (PAP) therapy: continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or adaptive servo-ventilation (ASV) Oxygen therapy: supplemental oxygen delivered through a nasal cannula or mask Medications, such as acetazolamide or theophylline, to stimulate breathing (used in specific cases) Treatment of underlying medical conditions, such as heart failure or stroke Lifestyle modifications, including weight loss, regular exercise, and avoiding alcohol and sedatives

Prognosis

The prognosis for individuals with central sleep apnea varies depending on the severity of the condition and the response to treatment. Proper management of the underlying cause and adherence to prescribed treatments can significantly improve breathing, sleep quality, and overall health. However, untreated or poorly managed central sleep apnea may lead to complications such as poor cardiovascular health, increased risk of stroke, and reduced quality of life.

Regular follow-up appointments with healthcare providers and consistent communication can help monitor progress and adjust treatments as needed, improving the overall prognosis and quality of life for those living with central sleep apnea.

See Also

• Obstructive Sleep Apnea
• Sleep Disorders
• Sleep Study
• Positive Airway Pressure
• Cheyne-Stokes Respiration

References

• Javaheri, S., & Dempsey, J. A. (2013). Central sleep apnea. Comprehensive Physiology, 3(1), 141–163. https://doi.org/10.1002/cphy.c110063
• Malhotra, A., & White, D. P. (2002). Central sleep apnea. Chest, 121(6), 1996–2008. https://doi.org/10.1378/chest.121.6.1996
• Javaheri, S. (2006). Central sleep apnea. Clinics in Chest Medicine, 27(2), 229–237. https://doi.org/10.1016/j.ccm.2005.12.002

Summary

The periodic cessation of breathing while asleep that occurs secondary to the decreased responsiveness of the respiratory center of the brain to carbon dioxide, resulting in alternating cycles of apnea and hyperpnea.

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