Elsevier

Sleep Medicine Clinics

Volume 12, Issue 4, December 2017, Pages 565-572
Sleep Medicine Clinics

Positive Airway Pressure Therapy for Hyperventilatory Central Sleep Apnea: Idiopathic, Heart Failure, Cerebrovascular Disease, and High Altitude

https://doi.org/10.1016/j.jsmc.2017.07.006Get rights and content

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Key points

  • Hyperventilatory central sleep apnea (CSA) and Hunter-Cheyne-Stokes breathing (HCSB) are caused by a temporary failure in the pontomedullary pacemaker generating breathing rhythm, caused by the existence of an apneic threshold for arterial Pco2 confined primarily to non–rapid eye movement sleep.

  • Common causes of hyperventilatory CSA/HCSB in adults are congestive heart failure and stroke.

  • Diagnosis and treatment of hyperventilatory CSA/HCSB may improve quality of life, and, when associated with

Idiopathic central sleep apnea

This is a rare polysomnographic finding in individuals otherwise thought to be free of comorbidities. There are multiple causes of CSA in otherwise asymptomatic individuals and some may have unrecognized disorders that might be the cause of the so-called idiopathic CSA. Examples include asymptomatic carotid artery stenosis and left ventricular systolic dysfunction. These potential causes of CSA, and others, were not systematically investigated in most reports of idiopathic CSA. Therefore,

Heart failure

Sleep disordered breathing (SDB), both obstructive and CSA/HCSB, commonly occurs in individuals with left ventricular dysfunction, which may be both systolic and diastolic. Most commonly CSA/HCSB occurs in patients with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). However, CSA/HCSB caused by left ventricular dysfunction often manifests the unique pattern of periodic breathing described as HCSB.2 The pattern of HCSB

Cerebrovascular disorders

A wide range of central nervous system disorders are associated with CSA, and, in most, the clinical significance remains to be elucidated. Furthermore, arterial blood gas levels have not always been systematically measured and therefore it is not known whether the pathogenesis is similar to what occurs in heart failure. Consequently, inclusion in the category of CSA may not be applicable to many of these disorders. This article concentrates on stroke, which is the most common neurologic reason

High altitude

On sojourn to high altitude, here defined as at or above 2500 to 3000 m, periodic breathing with CSA occurs almost universally. In general, the severity of CSA increases with altitude once a threshold of 2000 m is reached.4, 36

Individuals who abruptly move to high altitude frequently report sleep disturbances, including insomnia and restlessness. Much of this can be attributed to CSA, which fragments sleep because of arousals, as well as the effects of hypoxia by itself, hypocapnia induced by

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      2020, Sleep Medicine
      Citation Excerpt :

      The diagnosis of PCSA is one of exclusion where the disorder is not better explained by another sleep disorder, medical disorder, neurological disorder, medication use or substance use disorder [1,5]. There are few data on the prevalence and long-term outcomes of PCSA [1,6,7]. In this study we aimed to evaluate the proportion of patients with PSG-confirmed diagnosis of CSA who had PCSA, and to determine what disorders manifest over time following the diagnosis of PSCA.

    Financial Disclosures: S. Javaheri has no relevant conflicts of interest. L.K. Brown has participated in advisory panels for Philips Respironics, and is an insurance claims reviewer for Considine and Associates, Inc. He coedits the sleep and respiratory neurobiology section of Current Opinion in Pulmonary Medicine, wrote on continuous positive airway pressure treatment of obstructive sleep apnea in UpToDate and on obstructive sleep apnea in Clinical Decision Support: Pulmonary Medicine and Sleep Disorders. He is currently coediting an issue of Sleep Medicine Clinics on positive airway pressure therapy. He serves on the Polysomnography Practice Advisory Committee of the New Mexico Medical Board and chairs the New Mexico Respiratory Care Advisory Board.

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