Central sleep apnea

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Última revisão das evidências: 1 Jul 2026

Última atualização do tópico: 24 Dec 2024

Central sleep apnea (CSA) is characterized by repetitive apneas or hypopneas 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.

Definição

CSA syndromes are characterized 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 etiology 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][2] 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.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

abnormal heart rhythm or the presence of third or fourth heart sounds
focal abnormality on neurologic exam
neuromuscular weakness
history of endocrine disorders

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

overnight polysomnography

Detalhes completos

Investigações a serem consideradas

serum thyroid stimulating hormone
serum creatinine
ECG
serum insulin-like growth factor 1 (acromegaly testing)
echocardiogram

Detalhes completos

Algoritmo de tratamento

AGUDA

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

Colaboradores

Autores

Bernardo J. Selim, MD

Associate Professor of Medicine

Director of Respiratory Care Unit

Division of Pulmonary, Critical Care, and Sleep Medicine

Mayo Clinic

Rochester

Declarações

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

Declarações

LAT declares that she has no competing interests.

Agradecimentos

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.

Declarações

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

Revisores

Teofilo Lee-Chiong, MD

National Jewish Medical and Research Center

Denver

Declarações

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

Declarações

JAF declares that he has no competing interests.

Créditos aos pareceristas

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Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

American Academy of Sleep Medicine. The AASM international classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Texto completo

Randerath W, Verbraecken J, Andreas S, et al. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017 Jan;49(1):1600959.Texto completo Resumo

Mayer G, Arzt M, Braumann B, et al. German S3 guideline nonrestorative sleep/sleep disorders, chapter "sleep-related breathing disorders in adults," short version: German Sleep Society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, DGSM). Somnologie (Berl). 2017;21(4):290-301.Texto completo Resumo

Aurora RN, Bista SR, Casey KR, et al. 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. J Clin Sleep Med. 2016 May 15;12(5):757-61.Texto completo Resumo

Aurora RN, Chowdhuri S, Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep. 2012 Jan 1;35(1):17-40.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Obstructive sleep apnea
- Sleep-related hypoventilation/hypoxemic syndromes
- Depression
Mais Diagnósticos diferenciais
Diretrizes
- International classification of sleep disorders, 3rd edition, text revision (ICSD-3-TR)
- Sleep-disordered breathing and cardiac arrhythmias in adults: mechanistic insights and clinical implications: a scientific statement from the American Heart Association
Mais Diretrizes
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Central sleep apnea

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

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

Colaboradores

Autores

Bernardo J. Selim, MD

Declarações

Lauren A. Tobias, MD

Declarações

Agradecimentos

Declarações

Revisores

Teofilo Lee-Chiong, MD

Declarações

John A. Fleetham, MD, FRCP

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice