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Positional Central Sleep Apnea

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Positional Therapy in Obstructive Sleep Apnea

Abstract

In contrast to obstructive sleep-disordered breathing, much less is known about positional dependency in central sleep apnea. However, there is interesting preliminary evidence that positional dependency is also present in central sleep apnea, type Cheyne-Stokes breathing (CSA/CSB), possibly even with an estimated prevalence of up to 50 %. Only a few cases of positional dependency have been reported in idiopathic central sleep apnea.

CSA/CSB is common in heart failure patients and is characterized by a typical waxing and waning breathing pattern with alternating hyperventilation and central apneas. The pathophysiology is complex with several mechanisms interacting, including pulmonary congestion, enhanced chemosensitivity, prolonged circulation time, arousals from sleep and hypocapnia.

Most studies have investigated the effect of supine versus non-supine body position on severity of CSA/CSB, and one study reported on semi/recumbent body position and severity of CSA/CSB. Similar to obstructive sleep apnea, positional dependency in CSA/CSB is associated with less severe disease.

Mechanisms thought to be responsible for the positional dependency in CSA/CSB are influence of body position on cardiac function, upper airway instability, pulmonary volume and blood gas exchange.

In clinical practice, if positional dependency is present in CSA/CSB, positional therapy might be an alternative treatment especially in patients with CPAP failure. However, future research is warranted to validate this approach.

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Authors and Affiliations

  1. Sleep Medicine Centre, Kempenhaeghe, Heeze, 61, 5590 AB, The Netherlands

    Hennie Janssen M.D., Ph.D., Dirk Pevernagie M.D., Ph.D. & Sebastiaan Overeem M.D., Ph.D.

  2. Department of Pulmonary Medicine, Antwerp University Hospital, Edegem, Antwerp, Belgium

    Johan A. Verbraecken M.D., Ph.D.

  3. Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium

    Johan A. Verbraecken M.D., Ph.D.

Authors
  1. Hennie Janssen M.D., Ph.D.
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  2. Johan A. Verbraecken M.D., Ph.D.
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  3. Dirk Pevernagie M.D., Ph.D.
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  4. Sebastiaan Overeem M.D., Ph.D.
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Corresponding author

Correspondence to Hennie Janssen M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Otolaryngology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands

    Nico de Vries

  2. Department of Otorhinolaryngology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands

    Madeline Ravesloot

  3. Department of Otolaryngology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands

    J. Peter van Maanen

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Janssen, H., Verbraecken, J.A., Pevernagie, D., Overeem, S. (2015). Positional Central Sleep Apnea. In: de Vries, N., Ravesloot, M., van Maanen, J. (eds) Positional Therapy in Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-319-09626-1_19

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  • DOI: https://doi.org/10.1007/978-3-319-09626-1_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09625-4

  • Online ISBN: 978-3-319-09626-1

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