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.
Central sleep apnea (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 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. 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.
History and exam
Key diagnostic 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 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
Other diagnostic factors
- abnormal heart rhythm or the presence of third or fourth heart sounds
- focal abnormality on neurologic exam
- neuromuscular weakness
- history of endocrine disorders
- congestive heart failure
- renal failure
- male sex
- atrial fibrillation
- age ≥60 years
- opioid use
- brainstem lesions
- neuromuscular weakness
1st investigations to order
- overnight polysomnography
Investigations to consider
- serum thyroid stimulating hormone
- serum creatinine
- serum insulin-like growth factor 1 (acromegaly testing)
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
- Obstructive sleep apnea
- Sleep-related hypoventilation/hypoxemic syndromes
- Sleep-disordered breathing and cardiac arrhythmias in adults: mechanistic insights and clinical implications: a scientific statement from the American Heart Association
- The AASM manual for the scoring of sleep and associated events
Sleep apnea in adults (obstructive)More Patient leaflets
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