Central sleep apnoea

Last reviewed: 25 Aug 2022
Last updated: 28 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • insomnia, especially sleep-maintenance insomnia
  • poor concentration and attention span
  • observed periodic breathing or cessation of breathing or snoring during sleep (by partner)
  • transient dyspnoea that awakens from sleep or prevents sleep onset
  • headaches upon waking
  • complaints of poorly restorative sleep and/or daytime sleepiness
  • periodic breathing during wakefulness
More key diagnostic factors

Other diagnostic factors

  • abnormal heart rhythm or the presence of third or fourth heart sounds
  • focal abnormality on neurological examination
  • neuromuscular weakness
  • history of endocrine disorders
Other diagnostic factors

Risk factors

  • congestive heart failure
  • stroke
  • renal failure
  • male sex
  • atrial fibrillation
  • age ≥60 years
  • opioid use
  • brainstem lesions
  • neuromuscular weakness
  • acromegaly
  • hypothyroidism
More risk factors

Diagnostic investigations

1st investigations to order

  • overnight polysomnography
More 1st investigations to order

Investigations to consider

  • serum thyroid stimulating hormone
  • serum creatinine
  • ECG
  • serum insulin-like growth factor 1 (acromegaly testing)
  • echocardiogram
More investigations to consider

Treatment algorithm

ACUTE

without Cheyne-Stokes breathing: due to medical disorder

without Cheyne-Stokes breathing: primary (idiopathic)

with Cheyne-Stokes breathing

due to high-altitude periodic breathing

due to medication or substance misuse

treatment-emergent CSA

Contributors

Authors

Bernardo J. Selim, MD

Associate Professor of Medicine

Director of Respiratory Care Unit

Division of Pulmonary, Critical Care, and Sleep Medicine

Mayo Clinic

Rochester

MN

Disclosures

BJS declares that he has no competing interests.

Lauren A. Tobias, MD

Assistant Professor of Medicine

Yale University School of Medicine

Department of Internal Medicine

Section of Pulmonary, Critical Care and Sleep Medicine

New Haven

CT

Disclosures

LAT declares that she has no competing interests.

Acknowledgements

Dr Bernardo J. Selim and Dr Lauren A. Tobias would like to gratefully acknowledge Dr J. Shirine Allam, Dr Timothy I. Morgenthaler, and Dr Christine H. Won, previous contributors to this topic.

Disclosures

JSA and TIM declare that they have no competing interests. CHW declares that she has been a speaker for Respironics CME.

Peer reviewers

Teofilo Lee-Chiong, MD

National Jewish Medical and Research Center

Denver

CO

Disclosures

TLC has been reimbursed by the American College of Chest Physicians (ACCP), American Academy of Sleep Medicine, American Thoracic Society, and Cephalon, the manufacturer of modafinil, for attending several conferences. He has been paid by the ACCP for running educational programs and by Elsevier for serving as consultant of the Sleep Medicine Clinics. He has also received research funding from the National Institutes of Health, Respironics, Restore, and Schwarz Pharma, and has been a member of the speakers' bureau for GlaxoSmithKline.

John A. Fleetham, MD, FRCP

Professor

University of British Columbia

Vancouver

Canada

Disclosures

JAF declares that he has no competing interests.

  • Differentials

    • Obstructive sleep apnoea
    • Sleep-related hypoventilation/hypoxaemic syndromes
    • Depression
    More Differentials
  • Guidelines

    • The AASM manual for the scoring of sleep and associated events
    • German S3 guideline nonrestorative sleep/sleep disorders, chapter: sleep-related breathing disorders in adults
    More Guidelines
  • Patient leaflets

    Sleep apnoea in adults (obstructive)

    More Patient leaflets
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