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Central Sleep Apnea

Sleep-disordered breathing characterized by recurrent episodes of cessation of airflow due to absent or reduced respiratory effort (vs obstructive apnea), often associated with heart failure (Cheyne-Stokes respiration), opioid use, high-altitude exposure, or idiopathic causes.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göğüs Hastalıkları department. Book Appointment →

What is Central Sleep Apnea?

Central sleep apnea (CSA) is a sleep-disordered breathing characterized by recurrent episodes of cessation (apnea) or reduction (hypopnea) of airflow due to absent or diminished central respiratory drive (no respiratory effort), in contrast to obstructive sleep apnea (OSA) where effort continues against an obstructed airway. Polysomnography distinguishes the two by chest/abdominal effort signals.

Major subtypes include CSA with Cheyne-Stokes respiration (CSR-CSA, characteristic crescendo-decrescendo pattern, common in heart failure with reduced EF, stroke), opioid-induced CSA (cluster breathing pattern), high-altitude periodic breathing, treatment-emergent (complex) CSA after initiating CPAP for OSA, and idiopathic CSA. Pathogenesis involves PaCO2 control instability, hyperventilation-induced apnea threshold, and impaired chemoreceptor sensitivity.

Diagnosis requires in-laboratory polysomnography showing >5 central apneas/hypopneas per hour. Treatment is etiology-specific: optimization of heart failure (guideline-directed medical therapy with ACE-I/ARB, beta-blockers, MRA, SGLT2-i; cardiac resynchronization therapy), reduction or substitution of opioids, supplemental nocturnal oxygen, BiPAP with backup rate, and adaptive servo-ventilation (ASV) which monitors breathing and adjusts pressure breath-by-breath. Note: SERVE-HF trial showed increased mortality with ASV in HFrEF (LVEF <45%) with predominantly central apnea, so ASV is contraindicated in this group; use BiPAP-ST instead.

Symptoms

Witnessed apneas without snoring or with mild snoring
Cheyne-Stokes pattern: crescendo-decrescendo breathing with apnea
Daytime sleepiness, fatigue, poor concentration
Frequent nocturnal awakenings, paroxysmal nocturnal dyspnea
Insomnia (difficulty maintaining sleep)
Underlying heart failure, opioid use, or stroke history

Risk Factors

Heart failure with reduced ejection fraction (CSR-CSA)
Stroke (especially brainstem)
Chronic opioid use (methadone, morphine)
Atrial fibrillation
High-altitude exposure
Male sex, advanced age, CPAP for OSA (treatment-emergent)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Witnessed apneas without snoring
  • Excessive daytime sleepiness with heart failure
  • Cheyne-Stokes breathing observed by partner
  • Worsening sleep quality with opioid therapy
  • Persistent CSA after starting CPAP for OSA
  • Unexplained insomnia or paroxysmal nocturnal dyspnea

Treatment Methods

01
In-laboratory polysomnography (gold standard) to differentiate CSA from OSA
02
Echocardiography to assess for heart failure (especially HFrEF with CSR)
03
Optimize heart failure: GDMT (ACE-I/ARB/ARNI, beta-blockers, MRA, SGLT2-i), cardiac resynchronization therapy
04
Reduce or substitute opioids when feasible (CSA-related to opioids)
05
Supplemental nocturnal oxygen for CSR with hypoxemia
06
BiPAP-ST (with backup rate) for CSR in HFrEF
07
Adaptive servo-ventilation (ASV) — contraindicated in HFrEF with EF <45% (SERVE-HF), useful in idiopathic and treatment-emergent CSA
08
Phrenic nerve stimulation (remede system) for moderate-severe CSA
09
Acetazolamide for high-altitude or idiopathic CSA
10
Treat underlying conditions (atrial fibrillation, hypothyroidism)

Which Department to Visit?

You can visit our Göğüs Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.