Characterised by repetitive apnoeas or hypopnoeas with absent or diminished respiratory effort during sleep, occurring more than 5 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.
Central sleep apnoea (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 or secondary. CSA is most commonly encountered in clinical practice as a result of an underlying condition, notably congestive heart failure (CHF) with reduced or preserved ejection fraction, conferring a poor prognosis. Among forms of medication and substance abuse, opioid intake is another frequent clinical scenario that may lead to CSA. Primary CSA is an idiopathic rare disorder.
History and exam
- 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 arising
- complaints of poorly restorative sleep and/or daytime sleepiness
- periodic breathing during wakefulness
Bernardo J. Selim, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine
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
LAT declares that she has no competing interests.
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 monograph. JSA and TIM declare that they have no competing interests. CHW declares that she has been a speaker for Respironics CME.
Teofilo Lee-Chiong, MD
National Jewish Medical and Research Center
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
University of British Columbia
JAF declares that he has no competing interests.
Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses external link opens in a new windowMore guidelines
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