central sleep apnea

Central Sleep Apnea (CSA): A Disorder of Breathing During Sleep

Central sleep apnea is a disorder in which breathing stops and starts repeatedly during sleep, resulting from the brain's inability to transmit signals to the muscles that control breathing. This condition can be a complication of other medical conditions or occur independently.

Characteristics of CSA:

• Breathing cessation: Breathing stops and starts repeatedly during sleep.
• Lack of respiratory effort: In some cases, breathing is very shallow or absent.
• Changes in ventilatory drive: The brain's ability to regulate breathing is impaired.

Causes and Risk Factors:

• Complications from other medical conditions
• Brain damage or injury
• Neurological disorders

Symptoms:

• Pauses in breathing during sleep
• Shallow or absent breathing
• Morning headaches
• Fatigue and daytime sleepiness

Treatment Options:

• Using a machine that manages breathing (e.g., CPAP)
• Medications to stimulate breathing
• Lifestyle changes, such as weight loss and exercise

References:

• [1] Central sleep apnea occurs when your brain doesn't transmit signals to your breathing muscles. (Source: 1)
• [2-5] Central sleep apnea is a form of sleep apnea that may be a complication of other medical conditions. Using a machine that manages breathing may help. (Sources: 2-5)
• [6-8] Central sleep apnea is a disorder in which breathing stops and starts repeatedly during sleep, resulting from the brain's inability to transmit signals to the muscles that control breathing. This condition can be a complication of other medical conditions or occur independently. (Sources: 6-8)
• [9] CSA is different from obstructive sleep apnea (OSA), which causes abnormal breathing due to the collapse of the soft tissues in the back of the throat, leading to airway obstruction. (Source: 9)

Common symptoms associated with central sleep apnea include:

• Daytime sleepiness [1]
• Severe morning headaches [2]
• Repeatedly stopping breathing while asleep due to the brain not sending signals to breathe [4]

These symptoms are often experienced when awake, and can be a result of the underlying cause of central sleep apnea. It's worth noting that these symptoms can overlap with those of obstructive sleep apnea, making diagnosis challenging.

Other possible symptoms:

• Shortness of breath [7]
• Swallowing problems [7]
• Voice changes [7]
• Weakness or numbness throughout the body [7]

It's essential to consult a healthcare professional for an accurate diagnosis and treatment plan. They will evaluate your signs and symptoms, as well as perform diagnostic testing, to determine the best course of action.

References: [1] - Central sleep apnea is more common among older adults, especially those older than age 60. [2] - You experience most central sleep apnea symptoms when you’re awake. The following are a few symptoms associated with central sleep apnea: Daytime sleepiness. Severe morning headaches. [4] - In central sleep apnea, you repeatedly stop breathing while you sleep because your brain doesn’t tell your muscles to breathe. [7] - Symptoms · Shortness of breath · Swallowing problems · Voice changes · Weakness or numbness throughout the body ...

Central sleep apnea (CSA) can be diagnosed through various tests that evaluate different aspects of a person's physical and physiological condition.

Sleep Studies

• A full night polysomnogram (sleep study in a sleep laboratory) is the preferred diagnostic test for CSA, as it provides detailed information about breathing patterns, heart rate, and other bodily functions during sleep [6].
• This test can help determine whether lapses in breathing are caused by airway blockage or irregular signals from the brain [7].

Physical Examination

• A thorough physical examination is also an essential part of diagnosing CSA. The doctor will ask about symptoms and perform a physical check-up to identify any underlying conditions that may be contributing to CSA [8].
• This examination can help rule out other potential causes of sleep apnea, such as obesity or nasal congestion.

Additional Tests

• Other diagnostic tests that may be used to evaluate CSA include:
  • Echocardiogram: to assess heart function and detect any abnormalities [4]
  • Lung function testing: to measure lung capacity and detect any respiratory problems [4]
  • MRI of the brain, spine, or neck: to rule out any structural issues in these areas that may be contributing to CSA [4]
  • Blood tests, such as arterial blood gas levels: to evaluate oxygen levels and detect any underlying conditions that may be affecting breathing patterns [4]

Diagnostic Evaluation

• The diagnostic evaluation of CSA involves evaluating the patient's signs and symptoms in concert with diagnostic testing. This comprehensive approach can help identify the underlying causes of CSA and guide treatment decisions [5].

Note: These tests are not mutually exclusive, and a combination of them may be used to diagnose central sleep apnea.

References: [4] Aug 29, 2023 — Exams and Tests · Echocardiogram · Lung function testing · MRI of the brain, spine, or neck · Blood tests, such as arterial blood gas levels ... [5] Jan 8, 2013 — The diagnostic evaluation of CSA consists of evaluating the patient's signs and symptoms in concert with diagnostic testing. These factors ... [6] by N Liban Sigua · 2021 · Cited by 3 — Whenever there is a concern for CSA, the preferred diagnostic test is a full night polysomnogram (sleep study in a sleep laboratory) rather than a home sleep ... [7] Diagnosis. A thorough sleep study with polysomnography (PSG) will show whether the lapses in breathing result from airway blockage or irregular signals from the ... [8] Mar 10, 2020 — Diagnosing central sleep apnea usually begins with a physical examination. The doctor will ask the person what symptoms they are experiencing ...

Medications Used to Treat Central Sleep Apnea

Central sleep apnea (CSA) can be treated with various medications, which aim to stimulate breathing or reduce the frequency and severity of apneic episodes.

• Acetazolamide: This medication has been used to stimulate breathing in people with CSA. It works by increasing the levels of carbon dioxide in the blood, which stimulates the respiratory centers in the brain.
• Theophylline: Another medication that can be prescribed for CSA is theophylline, a bronchodilator that also has mild stimulant properties.
• Sedative-hypnotic agents: In some cases, sedative-hypnotic agents like zolpidem and triazolam may be considered for the treatment of primary central sleep apnea syndromes. However, their use is limited due to potential side effects.

Other Treatments

In addition to medications, other treatments such as positive airway pressure (PAP) systems, adaptive servo ventilation (ASV), oxygen therapy, and added dead space can also be used to manage CSA.

• Positive Airway Pressure (PAP): PAP systems are commonly used to treat obstructive sleep apnea (OSA), but they can also be effective in treating CSA. These systems work by delivering a constant flow of air pressure into the airways, preventing collapse and promoting normal breathing.
• Adaptive Servo Ventilation (ASV): ASV is another treatment option for CSA that uses a device to deliver a variable flow of air pressure based on the patient's respiratory needs.

Recent Developments

In 2023, the FDA approved a medical device called the Remede System, which is implanted in the chest and can help treat central sleep apnea. This development offers new hope for patients with CSA who have not responded to other treatments.

References:

• [1] Medicines such as acetazolamide have been used to stimulate breathing in people with central sleep apnea.
• [2] Several different medications aimed at improving central sleep apnea include acetazolamide, theophylline, and sedative-hypnotic agents.
• [3] Differently from obstructive sleep apnoea syndrome (OSAS), CSAS have been demonstrated to respond to some extent to pharmacological agents, such as zolpidem.
• [4] The use of zolpidem (Ambien) and triazolam (Halcion) may be considered for the treatment of primary central sleep apnea syndromes only if the patient has not responded to other treatments.
• [5] Several different treatments aimed at central sleep apnea include positive airway pressure, adaptive servo ventilation (ASV), oxygen, added dead space.
• [8] The FDA has approved a medical device (remede System) to treat central sleep apnea.

Central sleep apnea (CSA) can be challenging to diagnose, as it often presents with non-specific symptoms that can be attributed to other conditions. However, a thorough differential diagnosis is essential to rule out other potential causes.

Possible Causes of Central Sleep Apnea:

• Other Disorders: CSA can be associated with various medical conditions, including:
  • Stroke [6]
  • Diabetes mellitus [6]
  • Hypothyroidism [5]
  • Parkinson disease [6]
  • Multiple system atrophy or Shy-Drager syndrome [6]
• Medications: Certain medications, such as opioids, can contribute to CSA by reducing the drive to breathe during sleep [7].
• Sleepiness and Fatigue: Excessive daytime sleepiness, fatigue, or tiredness can be symptoms of CSA, but they are also common in other conditions, making differential diagnosis crucial [10].

Key Diagnostic Features:

• A single central apnea event is defined as a ≥10-second pause in ventilation with no associated respiratory effort; greater than five such events per hour during sleep [9].
• Physical examination characteristics often include loud snoring, witnessed apneas, and excessive daytime sleepiness [1].

Important Considerations:

• CSA can be a serious medical condition, and its complications should not be overlooked. Fatigue is one of the potential complications associated with CSA [2].
• Addressing associated medical problems is essential in the management of CSA.

References:

[1] - Context 1 [5] - Context 5 [6] - Context 6 [7] - Context 7 [9] - Context 9 [10] - Context 10