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. 2025 Feb 1;21(2):405-416.
doi: 10.5664/jcsm.11424.

Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel

Vaishnavi Kundel  1 , Anjali Ahn  2 , Michael Arzt  3 , Jerryll Asin  4 , Ali Azarbarzin  5 , Nancy Collop  6 , Aneesa Das  7 , James C Fang  8 , Rami Khayat  9 , Thomas Penzel  10 , Jean-Louis Pépin  11 , Sunil Sharma  12 , Maria V Suurna  13 , Sudha Tallavajhula  14 , Atul Malhotra  15
Affiliations

Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel

Vaishnavi Kundel et al. J Clin Sleep Med. .

Abstract

Central sleep apnea (CSA) is commonly encountered among patients with sleep-disordered breathing; however, its clinical consequences are less well-characterized. The senior author (A.M.) therefore convened an expert panel to discuss the common presentations of CSA, as well as challenges and knowledge gaps in the diagnosis and management of CSA. The panel identified several key research priorities essential for advancing our understanding of the disorder. Within the diagnostic realm, panel members discussed the utility of multinight assessments and importance of the development and validation of novel metrics and automated assessments for differentiating central vs obstructive hypopneas, such that their impact on clinical outcomes and management may be better evaluated. The panel also discussed the current therapeutic landscape for the management of CSA and agreed that therapies should primarily aim to alleviate sleep-related symptoms, after optimizing treatment to address the underlying cause. Most importantly, the panel concluded that there is a need to further investigate the clinical consequences of CSA, as well as the implications of therapy on clinical outcomes, particularly among those who are asymptomatic. Future research should focus on endo-phenotyping central events for a better mechanistic understanding of the disease, validating novel diagnostic methods for implementation in routine clinical practice, as well as the use of combination therapy and comparative effectiveness trials in elucidating the most efficacious interventions for managing CSA.

Citation: Kundel V, Ahn A, Arzt M, et al. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. J Clin Sleep Med. 2025;21(2):405-416.

Keywords: CSA; PAP; central hypopnea; central sleep apnea; phrenic nerve stimulation.

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Conflict of interest statement

The manuscript has been reviewed and approved by all authors. Work for this study was performed at the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, San Diego, CA. Dr. Malhotra organized the CSA Roundtable. He is a consultant for Zoll Medical, who offered an honorarium for participation to panel members. All panel members were invited by Dr. Malhotra as experts in the field, and the entirety of discussion with panel members was organized and led by the senior author. Zoll played no role in the operation of the consensus procedure, the composition and content of the manuscript, any revisions, or the decision to publish. The following authors disclose compensation for participation: Jeryll Asin, Vaishnavi Kundel, Thomas Penzel, Jean-Loius Pepin. Dr. Kundel is funded by the National Institutes of Health (NIH) and the American Academy of Sleep Medicine (AASM) Foundation. She reports fees related to Zoll and royalties from UpToDate. Dr. Ahn reports no conflicts of interest. Dr. Arzt is funded by the Else-Kroener-Fresenius Foundation, the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF), the German Academic Exchange Service (Deutscher Akademischer Austauschdienst, DAAD), Philips, and ResMed. He reports lecture and consulting fees from Zoll, Inspire, ResMed, and Philips. Dr. Asin is funded by Philips and Somnomed and is a consultant for Zoll Respicardia and Bioprojet. Dr. Azarbarzin is funded by the NIH and the AASM Foundation. He reports grant support from Somnifix and serves as consultant for Zoll Respicardia, Somnifix, Apnimed, Eli Lilly, Cerebra, and Inspire. Dr. Collop reports grant funding from Zoll (Rest) and Huxley Medical and royalties from UpToDate. Dr. Das reports royalties from UpToDate. Dr. Fang is on the Board of Directors for the Heart Failure Society of America and is funded by the NIH. He also reports consulting with AstraZeneca (REALIZE -K Data Safety Monitoring Board [DSMB]), Abbot (abtMI CEC), Windtree (SEISMIC-HF DSMB), and Quidel (abtBNP CEC). Dr. Khayat reports no conflicts of interest. Dr. Penzel is a shareholder of Advanced Sleep Research, the Siestagroup GmBH. He is a consultant to Cerebra, National Sleep Foundation, and Philips. He receives grants from Lowenstein Medical, Cidelec, and Novartis. He has received travel grants and speaker fees from Loewenstein Medical, Philips, Jazz Pharma, Idorsia, Bioprojet, and Somnico. Dr. Pépin is funded by the ANR (French national agency for research). He reports income related to medical education from Resmed, Bioprojet, Jazz, and Zoll. Dr. Sharma is on the speaker bureau and reports speaker fees from Zoll Respicardia. Dr. Suurna is a consultant for Inspire Medical and Nyxoah and is involved in clinical trial research for Nyxoah, Livanova, and Cryosa. Dr. Tallavajhula is a consultant and speaker for Zoll. Dr. Malhotra is funded by the NIH. He reports income related to medical education from Livanova, Eli Lilly, Jazz, and Zoll. ResMed provided a philanthropic donation to University of California, San Diego.

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