Central sleep apnoea

Central sleep apnoea (CSA) is characterised by repetitive apnoeas or hypopnoeas with absent or diminished respiratory effort during sleep, occurring 5 or more times per hour.

Important to search for underlying disorders such as congestive heart failure (CHF), renal failure, stroke, brainstem lesions, acromegaly, hypothyroidism, or opioid use.

Presence portends a poorer prognosis for CHF patients.

Management of the underlying disorder may suffice to resolve the condition.

Presenting symptoms may be the same as with other sleep-related breathing disorders. The disorder may be asymptomatic, observed by a partner, or detected on testing.

A polysomnogram is required for diagnosis.

CSA syndromes are characterised by repetitive absent or diminished respiratory efforts that occur intermittently or in a cyclical pattern predominantly during sleep. They are classified according to their underlying aetiology as primary (idiopathic) or secondary. CSA is most commonly encountered in clinical practice as a result of an underlying condition, notably congestive heart failure with reduced or preserved ejection fraction, conferring a poor prognosis.[1]American Academy of Sleep Medicine. The AASM international classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication]. https://aasm.org/clinical-resources/international-classification-sleep-disorders [2]Eckert DJ, Jordan AS, Merchia P, et al. Central sleep apnea: pathophysiology and treatment. Chest. 2007 Feb;131(2):595-607. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191 http://www.ncbi.nlm.nih.gov/pubmed/17296668?tool=bestpractice.com ​​ Among forms of medication and substance misuse, opioid intake is another frequent clinical scenario that may lead to CSA. Primary CSA is an idiopathic rare disorder.