EpistemisSleep apnea of central origin
Specialty: Respiratory.
Why it occurs
- Congestive heart failure with Cheyne-Stokes pattern during sleep (hyperventilation that sweeps CO2 below the central apnea threshold)
- Cerebrovascular accident (CVA) affecting the bulbar or pontine respiratory control centers
- Chronic treatment with high doses of opiates (methadone, morphine, oxycodone that blunt chemoreceptor sensitivity to carbon dioxide)
- Congenital or acquired central hypoventilation syndrome (Curse of Ondine, loss of autonomic respiratory control during sleep)
- Idiopathic (intrinsic instability of the respiratory control loop gain).
Initial workup
Complete nocturnal polysomnography with thoracoabdominal effort monitoring using inductance bands (to differentiate the absence of ventilatory effort characteristic of central versus obstructive apnea) and capnography; Transthoracic Doppler echocardiogram; Magnetic resonance imaging (MRI) of the brain of the posterior fossa and brainstem; Daytime arterial blood gas.
red flags
Presence of severe excessive daytime sleepiness with risk of traffic accidents, sudden nocturnal awakenings with a feeling of extreme suffocation and panic, complex cardiac arrhythmias during apneas, or associated severe pulmonary hypertension.
Standard management
- Adaptive servoventilation — SAV) (device of choice to stabilize ventilation in central apneas associated with heart failure, contraindicated if LVEF <45%
- Acetazolamide — diuretic, administered at a dose of 250 mg orally before sleeping to induce a mild metabolic acidosis that stimulates the respiratory center, reducing altitude or idiopathic central apneas
- Rotation or gradual reduction of opioid dosage under medical supervision.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 5
- Treatment options
- 3