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Central sleep apnea

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Evidence last reviewed: 23 Jul 2026
Topic last updated: 18 Aug 2026

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

  • signs of volume overload, abnormal heart rhythm or the presence of third or fourth heart sounds
  • focal abnormality on neurologic exam
  • neuromuscular weakness
Full details

Risk factors

  • heart failure
  • stroke
  • renal failure
  • male sex
  • atrial fibrillation
  • age ≥60 years
  • opioid use
  • brainstem lesions
  • acromegaly
Full details

Diagnostic tests

1st tests to order

  • overnight polysomnography
Full details

Tests to consider

  • home sleep testing
  • serum creatinine
  • ECG
  • serum insulin-like growth factor 1
  • echocardiogram
Full details

Treatment algorithm

ACUTE

due to medical disorder: without Cheyne-Stokes respiration

central sleep apnea with Cheyne-Stokes respiration

primary (idiopathic) central sleep apnea

due to high-altitude periodic breathing

due to drug or substance misuse

treatment-emergent central sleep apnea

Contributors

Authors

Rami N. Khayat, MD

Professor of Medicine

Chief, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine

Pennsylvania State University

Hershey, PA

Disclosures

RNK was a Vice Chair of the American Academy of Sleep Medicine Guideline Committee on the Treatment of Central Sleep Apnea.

Acknowledgements

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

Disclosures

BJS, LAT, 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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

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.Full text  Abstract

Badr MS, Khayat RN, Allam JS, et al. Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025 Dec 1;21(12):2181-91.Full text  Abstract

Randerath WJ, Schiza SE, Arzt M, et al. European Respiratory Society and European Sleep Research Society statement on the treatment of central sleep apnoea with adaptive servo-ventilation. Eur Respir J. 2025 Aug;66(2):2500263.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Obstructive sleep apnea
    • Sleep-related hypoventilation/hypoxemic syndromes
    • Depression
    More Differentials

  • Guidelines

    • Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline
    • European Respiratory Society and European Sleep Research Society statement on the treatment of central sleep apnoea with adaptive servo-ventilation
    More Guidelines
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