central sleep apnea
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Classification
- primary central sleep apnea
- Cheyne-Stokes respirations
- sleep-onset central apneas
- central apnea emerging during CPAP titration
- central apneas related to medical disorders or medication use
Etiology
- defects in metabolic control or respiratory muscles
- primary & secondary central alveolar hypoventilation syndrome
- respiratory muscle weakness
- transient instabilities in central respiratory drive
- sleep onset
- hyperventilation-induced hypocapnia
- prolonged circulation time
- inhibition of central respiratory drive by upper airway reflexes
- other
Pathology
- absence of respiratory effort associated with loss of airflow for at least 10 seconds[2]
- loss of output from central respiratory centers in the brainstem[2]
Laboratory
Management
- treat comorbidities[2]
- treatment of heart failure (Cheyne-Stokes respirations)[2][4]
- eliminate opiates[2]
- treat sleep-related symptoms
- adaptive servoventilation increases mortality in patients with CHF[3]
- supplemental oxygen may be of benefit, esp if due to CHF[3]
- CPAP of benefit[3][8]
- acetazolamide may be of benefit[3]
- zolpidem & triazolam may be of benefit if no risk factors for respiratory depression[3]
- respiratory stimulants such as medroxyprogesterone not recommended in[3]
- implantable transvenous phrenic nerve stimulator FDA-approved 2017[6][9]
- also see sleep apnea
More general terms
More specific terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1238
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Medical Knowledge Self Assessment Program (MKSAP) 15, 16. 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 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;35(1):17-40 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22215916
Selim BJ, Ramar K. Management of Sleep Apnea Syndromes in Heart Failure. Sleep Med Clin. 2017 Mar;12(1):107-121. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28159090
Cowie MR, Woehrle H, Wegscheider K et al Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. N Engl J Med. 2015 Sep 17;373(12):1095-105. Epub 2015 Sep 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26323938 Free PMC Article - ↑ 4.0 4.1 4.2 Yumino D, Bradley TD. Central sleep apnea and Cheyne-Stokes respiration. Proc Am Thorac Soc. 2008 Feb 15;5(2):226-36 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18250216
- ↑ Lowes R Implant to Treat Central Sleep Apnea Approved by FDA, Medscape - Oct 06, 2017. http://www.medscape.com/viewarticle/886744
FDA News Release. Oct 6, 2017 FDA approves implantable device to treat moderate to severe central sleep apnea. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm579506.htm - ↑ 6.0 6.1 Hernandez AB, Patil SP. Pathophysiology of central sleep apneas. Sleep Breath. 2016 May;20(2):467-82. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26782104
- ↑ Randerath W, Verbraecken J, Andreas S et al Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017 Jan 18;49(1). pii: 1600959. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27920092 Free Article
- ↑ 8.0 8.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ 9.0 9.1 Lou N Phrenic Nerve Stimulation Holds Up for Central Sleep Apnea - Apnea indices, daytime sleepiness improved over 5 years. MedPage Today October 5, 2020 https://www.medpagetoday.com/meetingcoverage/hfsa/88963
Costanzo MR, et al Transvenous phrenic nerve stimulation in patients with central sleep apnea: 5-year safety and efficacy results Heart Failure Society of America (HFSA) 2020.