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Current Pulmonology Reports

, Volume 8, Issue 1, pp 14–21 | Cite as

Central Sleep Apnea: a Brief Review

  • M. Safwan BadrEmail author
  • Shahrokh Javaheri
Sleeping and Breathing (S Shafazand, Section Editor)
  • 28 Downloads
Part of the following topical collections:
  1. Topical Collection on Sleeping and Breathing

Abstract

Purpose of Review

The purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis, and treatment, including areas of controversy and uncertainty.

Recent Findings

Central apnea may be due to hypoventilation or to hypocapnia following hyperventilation. The occurrence of central apnea initiates a cascade of events that perpetuates breathing instability, recurrent central apnea, and upper airway narrowing. In fact, breathing instability and upper airway narrowing are key elements of central and obstructive apnea. Clinically, central apnea is noted in association with obstructive sleep apnea, heart failure, atrial fibrillation, cerebrovascular accident tetraplegia, and chronic opioid use. Management strategies for central apnea aim to eliminate abnormal respiratory events, stabilize sleep, and alleviate the underlying clinical condition. Positive pressure therapy (PAP) remains a standard therapy for central as well as obstructive apnea. Other treatment options include adaptive servo-ventilation (ASV), supplemental oxygen, phrenic nerve stimulation, and pharmacologic therapy. However, ASV is contraindicated in patients with central sleep apnea who had heart failure with reduced ejection fraction, owing to increased mortality in this population.

Summary

There are several therapeutic options for central apnea. Randomized controlled studies are needed to ascertain the long-term effectiveness of individual, or combination, treatment modalities in different types of central apnea.

Keywords

Central apnea Sleep Opioid Heart failure Positive pressure therapy CPAP BPAP Adaptive servo-ventilation 

Notes

Compliance with Ethical Standards

Conflict of Interest

Shahrokh Javaheri reports fees from Respicardia as a consultant.

M. Safwan Badr declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Division of Pulmonary, Critical; Care and Sleep MedicineWayne State University School of MedicineDetroitUSA
  2. 2.John D. Dingell VA Medical CenterWayne State University School of MedicineDetroitUSA
  3. 3.Sleep LaboratoryBethesda North HospitalCincinnatiUSA
  4. 4.Division of Pulmonary Sleep and Critical Medicine, College of MedicineUniversity of CincinnatiCincinnatiUSA
  5. 5.Division of CardiologyThe Ohio State UniversityColumbusUSA

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