✓ Evidence Based

Central Sleep Apnea: Types, Symptoms, Causes, and Treatment

Research on sleep patterns reveals that a small percentage, approximately 0.9%, of adults in the United States experience central sleep apnea (CSA). This condition is more prevalent among individuals aged 40 and above (1).

What is Central Sleep Apnea?

Central Sleep Apnea (CSA) is a sleep disorder characterized by recurrent interruptions in breathing during sleep. Unlike obstructive sleep apnea (OSA), where airway obstruction causes breathing cessation, CSA occurs due to the brain’s inability to send proper signals to the respiratory muscles (2).

While OSA is more prevalent, CSA is less common and often associated with underlying medical conditions such as heart failure, stroke, or sleeping at high altitudes.

Types of Central Sleep Apnea

Central sleep apnea manifests in several distinct forms (2), each stemming from different underlying causes. Here’s an overview of the various types:

  • Cheyne-Stokes Breathing: Characterized by fluctuating breathing patterns, including periods of acceleration, deceleration, cessation, and resumption, with each cycle lasting between 30-120 seconds. This type commonly manifests in individuals with a history of heart failure, accounting for approximately half of all CSA cases (3).
  • High-Altitude Periodic Breathing: Exposure to high elevations, typically above 2,500 meters (8,000 feet), may induce breathing difficulties in some individuals (4).
  • Narcotic-Induced CSA: Certain opioid medications such as oxycodone, morphine, and codeine may disrupt normal breathing patterns, contributing to CSA (5).
  • Idiopathic CSA: In cases where no clear underlying cause may be identified, CSA is termed idiopathic or primary (6).
  • Treatment-Emergent Apnea: Occurring in 5% to 15% of individuals undergoing positive airway pressure treatment for obstructive sleep apnea, CSA may emerge as a complication of therapy (7).

There’s also a related condition known as congenital central hypoventilation syndrome (CCHS), also referred to as Ondine’s curse, which is associated with a specific genetic anomaly. This syndrome affects approximately one in 200,000 children globally (8).

Understanding the diverse types of CSA is crucial for accurate diagnosis and effective management. Early recognition and intervention are key to improving patient outcomes and enhancing quality of life.

Symptoms of Central Sleep Apnea

Recognizing the symptoms of central sleep apnea is crucial for early detection and intervention. Common indications of CSA include (2):

  • Morning headaches
  • Frequent nighttime awakenings
  • Daytime fatigue

These symptoms collectively highlight the pervasive impact of CSA on both physical and cognitive well-being. Early recognition and management are paramount to mitigate associated risks and improve overall quality of life.

Causes and Risk Factors of Central Sleep Apnea

Central sleep apnea is influenced by various factors that may heighten an individual’s risk of experiencing it. Understanding these factors is crucial for identifying potential vulnerabilities:

  • Age: The likelihood of central sleep apnea escalates with age, particularly among individuals surpassing 60 years (6).
  • Neurological Conditions: Conditions affecting the brain, such as stroke, brain tumors, or structural abnormalities in the brainstem, may disrupt the brain’s regulation of breathing (9), thus predisposing individuals to central sleep apnea.
  • Heart Disorders: Individuals with underlying heart conditions face an elevated risk of central sleep apnea. Atrial fibrillation, characterized by irregular heartbeats, and congestive heart failure, where the heart struggles to pump blood adequately, are notable contributors (10).
  • High Altitude: Sleeping at higher altitudes than accustomed to may heighten the risk of experiencing sleep apnea. Fortunately, this condition typically resolves within a few weeks upon returning to lower altitudes (11)
  • CPAP Therapy: While continuous positive airway pressure (CPAP) therapy is effective for treating obstructive sleep apnea, some individuals may develop central sleep apnea as a complication, termed treatment-emergent central sleep apnea. This condition arises as a combination of obstructive and central sleep apneas (12)
  • Opioid Use: Taking opioid medications has been linked to an increased risk of central sleep apnea (13)

For individuals experiencing complex sleep apnea, consistent use of CPAP devices may lead to its resolution. Alternatively, other positive airway pressure therapies may be recommended for effective management.

Diagnosis of Central Sleep Apnea

To diagnose central sleep apnea, your physician will conduct a thorough physical examination and inquire about your medical history, including any sleep-related symptoms you may be experiencing (14) .

A key diagnostic tool for central sleep apnea is a polysomnogram , commonly known as a sleep study (15). During this study, you will spend the night in a specialized sleep laboratory, where trained specialists will meticulously monitor and record various aspects of your sleep, including:

  • Brain activity (electrical signals)
  • Eye movements
  • Muscle activity
  • Breathing patterns
  • Heart rate
  • Blood oxygen levels
  • Airflow

The polysomnogram allows the technologist to observe how often you experience apneic events, where breathing stops or becomes significantly reduced during sleep (16). Based on the results, the severity of your central sleep apnea may be determined.

While sleep studies conducted at home may effectively diagnose obstructive sleep apnea, they may not provide sufficient data for diagnosing central sleep apnea due to its distinctive characteristics. Therefore, a polysomnogram conducted in a specialized sleep laboratory is typically recommended for accurate diagnosis and assessment of central sleep apnea.

Treatment of Central Sleep Apnea

Treatment for central sleep apnea focuses on addressing underlying medical conditions, reducing the use of opioid medications, and using devices to assist with breathing during sleep.

  • Addressing Associated Medical Problems: Many cases of central sleep apnea are associated with other medical conditions such as heart failure. Treating these underlying conditions may often improve central sleep apnea symptoms. For example, therapy for heart failure may lead to improvements in breathing patterns during sleep (17).
  • Adaptive Servo-Ventilation (ASV): If CPAP alone is not effective, ASV may be recommended. ASV devices adjust the airflow pressure on a breath-by-breath basis to match the individual’s breathing pattern, thereby stabilizing respiration during sleep. However, ASV is not suitable for individuals with symptomatic heart failure (18).
  • Reduction of Opioid Medicines: If opioid medications are identified as a cause of central sleep apnea, healthcare providers may gradually reduce the dosage over time. This approach aims to alleviate the respiratory suppression effects of opioids, which may contribute to sleep apnea (19).
  • Supplemental Oxygen Therapy: Supplemental oxygen may be beneficial for individuals with central sleep apnea, as it helps to increase the oxygen levels in the bloodstream during sleep (20).
  • Bilevel Positive Airway Pressure (BPAP): Similar to ASV, BPAP devices deliver varying levels of air pressure during inhalation and exhalation. Unlike ASV, BPAP maintains a fixed pressure during inhalation, and it may also be programmed to deliver breaths if no spontaneous breathing is detected within a set timeframe (21).
  • Medications: In some cases, medications such as acetazolamide may be prescribed to stimulate breathing and improve respiratory function during sleep, particularly for individuals who cannot tolerate positive airway pressure therapy (22).

Collaborative care between healthcare providers and patients is essential to tailor treatment strategies to individual needs and improve sleep quality and overall health outcomes.

Conclusion

Central Sleep Apnea is a serious sleep disorder that may have significant implications for an individual’s health and quality of life. By understanding the symptoms, causes, and treatment options available, individuals with CSA may take proactive steps to manage their condition and improve their overall well-being.

If you or someone you know is experiencing symptoms of CSA, don’t hesitate to seek medical attention and support from healthcare professionals. With proper diagnosis and treatment, it is possible to effectively manage CSA and enjoy restful, rejuvenating sleep once again.