CENTRAL SLEEP APNEA




Central sleep apnea (CSA) is much less common than obstructive sleep apnea (OSA) and is also less well understood. Unfortunately, CSA's health effects are just as serious. Actually, they are more serious because central sleep apnia is basically when the brain stops sending signals to breathe. Pretty serious problem if you ask me. With obstructive sleep apnea, the airway is blocked thus resulting in the condition, but in Central Apnea it’s mostly related to the brain not giving proper signals. The heart will beat regardless of what the brain is doing but unfortunately, the lungs are not as motivated. They need to be told to breathe while the heart does not need to be told the beat.

Fortunately, central apnea is much less common than obstructive sleep apnea (OSA). However, it is considered more dangerous because of the ultimate consequences, one being death.


According to the American Academy of Sleep Medicine, central sleep apnia is classified into the following types:

Primary Central Sleep Apnea:

  • This condition is defined as at least five central apneas per hour of sleep.
  • It is still not clear whether there are long term effects on the heart or vascular system from this disorder.
  • When diagnosing primary central sleep apnia, doctors want to be sure that they are not dealing with other serious disorders of breathing during sleep such as obstructive sleep apnea or Cheyne-Stokes breathing. Also, they are looking for potential breathing disorders while awake that may be more prominent during sleep such as chronic lung diseases like emphysema, or chest wall or neuromuscular disorders.


CSA due to Cheyne-Stokes Breathing Pattern:

  • It is defined as cyclic waxing and waning of breathing effort in sleep, in association with a heart failure, stroke, or renal failure, typically in a very regular pattern which resembles a diamond shape.
  • This type of CSA occurs when breathing becomes very shallow and it will often cease completely for 10 or more seconds. This is the central apnea of Cheyne-Stokes breathing.
  • Patients with chronic heart failure have a high risk of having this form of sleep apnea.

Central Sleep Apnea due to High Altitude Periodic Breathing:

  • This form of sleep apnea is very similar to that seen in Cheyne-Stokes breathing.
  • This abnormal breathing in sleep occurs by definition in persons who have ascended to altitudes generally 4,000 meters and higher.
  • The central apneas are associated with repetitive arousals from sleep thus fragmenting sleep, as well as causing decreased oxygen level in the blood.

Central Sleep Apnia due to a Medical Condition (other than Cheyne Stokes Breathing):

There are numerous medical conditions which predispose an individual to having central apneas during sleep such as:

  • Neurologic disorders and/or muscular weaknesses or deformities of the chest wall or spine. This includes patients with disorders such as muscular dystrophy and amyotrophic lateral sclerosis, kyphoscoliosis, and post-polio disorders.

CSA due to a Drug or Substance:

  • Abnormal breathing in sleep, which may include hypoventilation as well as central sleep apnea, is usually seen after several months of use of the substance, although the effects of an overdose can occur more acutely.
  • Such substances are taken in combination with other respiratory suppressant medication, including substances such as benzodiazepines and alcohol.

Primary Sleep Apnea of Infancy:

  • Characterized by abnormal breathing pauses in infants generally of 20 seconds or greater.
  • Tend to occur in rapid-eye movement (REM) sleep.
  • Thought to be associated with a problem of the central nervous system breathing control due to immaturity of the system, or to some other medical, neurologic, or metabolic disturbance.
  • The International Classification of Sleep Disorders of the American Academy of Sleep Medicine states that "although a small percentage of sudden infant death syndrome (SIDS) victims experience apnea symptoms prior to death, primary apnea in the newborn or infant has not been established as an independent risk factor for SIDS."



Conditions that can cause central sleep apnea include:

  • Bulbar poliomyelitis
  • Encephalitis affecting the brainstem
  • Neurodegenerative illnesses
  • Stroke affecting the brainstem



Symptoms of Central Sleep Apnia include:

  • Chronic fatigue
  • Daytime sleepiness
  • Morning headaches
  • Restless sleep

Other symptoms may occur if the apnea is due to a neurological condition.

  • Difficulty swallowing
  • Voice changes
  • Weakness or numbness throughout the body



How is central sleep apnea this diagnosed?

  • Lung and breathing studies
  • All-night polygraphic sleep monitoring
  • MRI
  • Tests to diagnose underlying medical conditions

If central sleep apnea is due to heart failure, the goal is to treat the heart failure itself. In the case of idiopathic apnea or brainstem problems, nasal CPAP may be used to allow breathing.


Other Information about Central Sleep Apnea.

For idiopathic apnea, the outlook is usually favorable. In congestive heart failure, an aggressive treatment of the heart may improve the outlook. If the cause is a brainstem injury, the outlook tends to be worse. Complications may result from prolonged mechanical ventilation and from the underlying disease causing the syndrome.

Call your health care provider if you have symptoms that might indicate sleep apnea. Central sleep apnea is usually diagnosed in patients who are already severely ill.

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