Central Sleep Apnea

What Is Central Sleep Apnea?

Central Sleep Apnea (CSA) is a type of apnea that occurs when the brain is unable to transmit signals to the muscles of the body that are involved with breathing – namely the diaphragm and intercostal muscles. CSA is often seen in patients with heart failure, with around 30-80% of cases being diagnosed with the sleep disorder.

What Is The Difference Between Obstructive and Central Sleep Apnea?​​

CSA differs from obstructive sleep apnea (OSA) in that CSA is a neurological disorder, whereas OSA is caused by a physical blockage of the upper airway.

Furthermore, CSA is found to be less common compared to OSA.

Treatment

Treatment for CSA may require the patient to treat a pre-existing condition, or alter their current lifestyle choices. Overall, treatment options will differ depending on the individual person.

Continuous Positive Airway Pressure (CPAP)

CPAP is considered as the first-line of treatment for patients suffering from CSA. This method is also popular for the treatment of OSA (the most common type of sleep apnea).

CPAP involves wearing a face-mask that applies a mild amount of air pressure to the upper airway through the individual’s nose and/or mouth. This is used to keep the upper airway open, and allow the individual to breathe properly while sleeping.

Adaptive Servo-ventilation (ASV)

An alternative treatment option to CPAP is ASV, which is similar to CPAP in that it also delivers pressurised air to the upper airway. This type of therapy is generally reserved for special case patients.

The biggest difference between ASV and CPAP is that ASV machines are able to detect the amount of air pressure needed ‘breathe-to-breathe’, and then adjust accordingly to that reading. Both types of therapy use similar looking machines, although ASV machines differ in the technology and settings they use.

Oxygen Therapy

Oxygen Therapy may also be a viable option for you to consider.

Reduce Alcohol/Medication Intake

It may be beneficial for you to gradually reduce the amount of medication you are taking if the medication is having an impact on your CSA.

Opioids are a class of drug that have been shown to cause CSA. These drugs are usually prescribed for the treatment of chronic pain.[3]

Medication

A health professional will be able to sit down with you and discuss your medication options.

There are several different types of medications that are used to treat CSA, including: acetazolamide (Diamox), and theophylline (Theo-24, Theochron, etc.).

Acetazolamide

A study published in 2005 showed that patients with heart failure who were issued a single dose of acetazolamide before sleep showed an improvement in CSA and the daytime symptoms associated with the disorder.[1]

Theophylline

A study published in 1996 showed that theophylline was able to reduce the number of apneas experienced during sleep in patients with heart failure.[2]

Addressing a Pre-Existing Medical Condition

It is possible that an existing condition may be causing the occurrence of CSA. Treatment may involve therapy for problems such as heart failure or stroke.

Causes

The exact cause of CSA is still currently unknown. What we do know is that CSA involves our cardiovascular system, autonomic nervous system, and pulmonary system. This means our heart, nervous system, and lungs are all involved with CSA in some capacity.

In saying that though, there are several factors that have been shown to influence the development of CSA that we will cover in this section.

What Are the Causes of Central Sleep Apnea?

As previously mentioned, CSA occurs when the brain is unable to send signals to the muscles that are involved with breathing.

CSA is brought on by issues involving the brainstem, which is an area of the brain that is connected to the spinal cord. The brainstem is comprised of three different sections: the midbrain, the pons, and the medulla.

The medulla is responsible for the regulation of our breathing and heart rate. It is comprised of two different regions: the ventral region, and the dorsal region.

The ventral region of the medulla is associated with our ability to exhale, and the dorsal region is associated with our ability to inhale.

Conditions that can cause CSA include (overview):

  • Issues affecting the brainstem (i.e. stroke, tumour, or an infection)
  • Obesity
  • Certain medication (i.e. opioids)

Symptoms

The most common symptoms associated with CSA are:

  • Difficulty staying/falling asleep
  • Excessive daytime fatigue
  • Disrupted sleep with frequent awakenings
  • Abnormal breathing patterns during sleep (i.e. pauses in breathing)
  • Previous heart failure

Daytime fatigue is one of the most common symptoms associated with CSA, which is caused by a disruptive sleep due to frequent awakenings. Patients who suffer from CSA will wake up multiple times during the night – usually awakening with a shortness of breath.

CSA has been shown to occur in patients who have a history of heart problems, in particular those who have experienced heart failure before.

Other symptoms of CSA may also include:

  • Snoring
  • Shortness of breath when waking up
  • Morning headaches
  • Difficulty in concentration
  • Changes in mood

A family member or partner will be able to indicate whether or not you snore at night. This symptom is much more predominant in patients who have OSA compared to CSA. Furthermore, they will also be able to identify whether or not you stop breathing while you are asleep.

Diagnosis

CSA can be diagnosed properly with an overnight sleep study test. Several recordings will be taken during this test, such as your breathing pattern, brain activity, heart rate, and muscle movement.      

Classifications

According to the International Classification of Sleep Disorders (ICSD-3) CSA can be divided into a number of different categories:

  • Central sleep apnoea with Cheyne-Stokes breathing
  • Central apnoea due to a medical disorder without Cheyne-Stokes breathing
  • Central sleep apnoea due to high-altitude periodic breathing
  • Central sleep apnoea due to medication or substance
  • Primary central sleep apnoea
  • Primary central sleep apnoea of infancy
  • Primary central sleep apnoea of prematurity
  • Treatment-emergent central sleep apnoea

Cheyne-Stokes is defined as an abnormal pattern of breathing. It was named after the two physicians who first identified it, John Cheyne, and William Stokes.

References

  1. Javaheri, S., 2006. Acetazolamide improves central sleep apnea in heart failure: a double-blind, prospective study. American journal of respiratory and critical care medicine, 173(2), pp.234-237.
  2. Javaheri, S., Parker, T.J., Wexler, L., Liming, J.D., Lindower, P. and Roselle, G.A., 1996. Effect of theophylline on sleep-disordered breathing in heart failureNew England Journal of Medicine335(8), pp.562-567.
  3. Javaheri, S. and Patel, S., 2017. Opioids cause central and complex sleep apnea in humans and reversal with discontinuation: a plea for detoxification. Journal of Clinical Sleep Medicine, 13(06), pp.829-833.

DISCLAMER: The information on this page is intended for educational purposes only. It should not be used as a substitute for proper medical attention. If you would like to know more then please read our disclaimer

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