Central sleep apnea
Summary
Definition
Anamnesis y examen
Principales factores de diagnóstico
- 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
Otros factores de diagnóstico
- abnormal heart rhythm or the presence of third or fourth heart sounds
- focal abnormality on neurologic exam
- neuromuscular weakness
- history of endocrine disorders
Factores de riesgo
- congestive heart failure
- stroke
- renal failure
- male sex
- atrial fibrillation
- age ≥60 years
- opioid use
- brainstem lesions
- neuromuscular weakness
- acromegaly
- hypothyroidism
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- overnight polysomnography
Pruebas diagnósticas que deben considerarse
- serum thyroid stimulating hormone
- serum creatinine
- ECG
- serum insulin-like growth factor 1 (acromegaly testing)
- echocardiogram
Algoritmo de tratamiento
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
MN
Divulgaciones
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
Divulgaciones
LAT declares that she has no competing interests.
Agradecimientos
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.
Divulgaciones
JSA and TIM declare that they have no competing interests. CHW declares that she has been a speaker for Respironics CME.
Revisores por pares
Teofilo Lee-Chiong, MD
National Jewish Medical and Research Center
Denver
CO
Divulgaciones
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
Divulgaciones
JAF declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
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 Resumen
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 Resumen
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 Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Obstructive sleep apnea
- Sleep-related hypoventilation/hypoxemic syndromes
- Depression
Más DiferencialesGuías de práctica clínica
- 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
Más Guías de práctica clínicaFolletos para el paciente
Sleep apnea in adults (obstructive)
Más Folletos para el paciente
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