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Central Sleep Apnea

Central sleep apnea is not a single disease entity, but rather include several disorders in which the common abnormality is the withdrawal of effective central drive to the respiratory muscles.

In some people, recurrent central sleep apneas during sleep are not associated with any clinical manifestation or physiologic disturbances. In others, they present with symptoms of morning fatigue, daytime sleepiness, morning headache, and recurrent nocturnal awakenings. One of the common form of central apnea is known as Cheyne-stokes respiration. The Cheyne-srokes respiration is a pattern of breathing characterized by deep inspiratory cycle interchanged with complete cessation of breathing. This form of respiration is commonly seen in patients with congestive heart failure, being present in 30% to 40%. Its presence indicates a shorter survival compared to those who do not have this type of breathing.

Diagnosis

The diagnosis of Cheyne-Stokes respiration requires an overnight polysomnography performed in a sleep laboratory. Screening tools for Cheyne-Stokes respiration are under development (to be added soon).

Treatment

The first line of treatment is to optimize treatment for congestive heart failure. The addition of angiotensin converting enzyme inhibitors, digoxin or increasing the diuretics are among the potential therapeutic interventions. Among those with persistent Cheyne-Stokes respiration, various forms of continuous positive airways pressure (CPAP) have been advocated. The use of CPAP has been shown to improve cardiac function, quality of life and reduce the need for transplantation.