Central Sleep Apnea

Pulmonary and Critical Care Division, Wayne State University School of Medicine, Harper University Hospital, 3-Hudson, 3990 John R. Street, Detroit, MI 48201, USA.
Primary Care Clinics in Office Practice (Impact Factor: 0.74). 07/2005; 32(2):361-74, vi. DOI: 10.1016/j.pop.2005.02.003
Source: PubMed


Central sleep apnea (CSA) is characterized by the periodic occurrence of apnea caused by loss of ventilatory motor output. CSA is often discussed as a minor variant of obstructive sleep apnea.However, this view obscures the critical contribution of CSA as an important manifestation of breathing instability in a variety of conditions with diverse causes. Central apnea can also be a physiologic phenomenon in healthy people during sleep onset. Conversely, patients who have obstructive apnea may also develop episodes of apparent central apnea, and apneas that begin as central may become obstructive as respiratory effort is restored ("mixed apneas"). Thus, there is a significant overlap between obstructive and central apnea. This article addresses the pathophysiology, clinical features, and management of normocapnic and hypercapnic CSA.

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    • "Sleep apnea syndromes are characterized by periodic cessations of breathing during sleep . The classifications of these disordered breathing patterns include : 1 ) OSA , defined as oronasal blockage of airflow during normal respiratory effort ; 2 ) Central Sleep Apnea , defined as the complete cessation of respiratory muscle contraction ; and 3 ) Mixed Sleep Apnea , defined as presentation of the features encompassing both obstructive and central apnea [ Guilleminault et al , 1998 ; Halvorson et al , 1998 ; Lalloo et al , 1998 ; Kyzer et al , 1998 ; Sin et al , 1999 ] . Clinical diagnoses of these sleep disorders are confirmed by polysomnography ( PSG ) , which is completed via overnight observation in a sleep laboratory . "
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    ABSTRACT: SUMMARY Central Sleep Apnea Syndrome Central sleep apnea syndrome (CSAS) is a disorder characterized by repeated apneic events during sleep with no associ- ated ventilatory effort. CSAS is classified as either hypercapnic or nonhypercapnic. In the hypercapnic form of CSAS, inc- reases in PaCO2 generally result from reductions in ventilation or outright apneas due to an underlying depression of res- piratory drive. Hypercapnic CSAS is common in central hypoventilation syndromes which may be primary (idiopathic) or secondary to other disorders that cause damage to the respiratory center. Nonhypercapnic CSAS is not associated with eit- her a primary reduction in respiratory drive or respiratory muscle weakness. Nonhypercapnic CSAS can be a primary di- sorder or can occur secondary to high altitude, other medical illnesses such as congestive heart failure and central nervo- us system disease.
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    ABSTRACT: In summary, disordered sleep can present in a complex and atypical fashion in which the primary sleep-related component may not be immediately apparent. A high index of suspicion serves the clinician well in these cases. A careful and systematic evaluation of sleep often proves to be rewarding in terms of diagnostic accuracy and improved treatment outcome.
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