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Central Sleep Apnea and Obesity Hypoventilation Syndromes

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Primary Care Sleep Medicine

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Abstract

Central sleep apnea (CSA) is increasingly being recognized as an important contributor to morbidity and mortality, particularly when this form of sleep-disordered breathing complicates a variety of coexisting conditions. Two major categories of CSA have been described: hyperventilatory CSA, a frequent complication of CHF, stroke, hypoxemia, or residence at high altitude, and hypoventilatory CSA, which may occur in the setting of ventilatory impairment from neurological or neuromuscular disease or with chronic use of opioids. Hyperventilatory CSA (which may also exhibit the pattern of Hunter-Cheyne-Stokes respiration) is a manifestation of unstable control of breathing that may be due to one or more of the following factors: elevated CO2 chemosensitivity, prolonged circulation time, frequent sleep/wake transitions, or reduced pulmonary O2 and CO2 stores. Hypoventilatory CSA emerges when disease or drugs affect medullary respiratory control centers, or in disorders that interrupt innervation of the respiratory muscles or the functioning of the respiratory muscles themselves. The management of CSA depends on properly identifying whether it is hyper- or hypoventilatory through polysomnography, arterial blood gas determination, and other diagnostic modalities, investigating for the presence of coexisting obstructive sleep disordered breathing, and then selecting and validating a proper treatment modality. Hyperventilatory CSA most often responds to treatment of the underlying disorder and oxygen administration and/or positive airway pressure therapy. Hypoventilatory CSA often requires noninvasive positive pressure ventilatory assistance.

Obesity hypoventilation syndrome (OHS) often complicates severe obstructive sleep apnea (OSA), but may also occur when OSA is minimally present or not seen at all. OHS carries with it a high potential for morbidity and mortality. OHS often remits with treatment of concomitant OSA (if present), but when this fails, noninvasive positive pressure ventilatory support modes are necessary.

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Financial Disclosures

Dr. Dharia has no potential conflicts of interest to disclose. Dr. Brown serves on the Polysomnography Practice Advisory Committee of the New Mexico Medical Board and on the New Mexico Respiratory Care Advisory Board. He currently receives no grant or commercial funding pertinent to the subject of this chapter.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Ave NE, Building 2, Albuquerque, NM, 87102, USA

    Sushma M. Dharia M.D.

  2. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Avenue, Building 2, Albuquerque, NM, 87102, USA

    Lee K. Brown M.D.

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Correspondence to Lee K. Brown M.D. .

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  1. Sleep Disorders Center, Pueblo, Colorado, USA

    James F. Pagel

  2. Department of Population Health, New York University School of Medicine / Center for Healthful Behavior Change, New York, New York, USA

    S. R. Pandi-Perumal

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Dharia, S.M., Brown, L.K. (2014). Central Sleep Apnea and Obesity Hypoventilation Syndromes. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_12

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