Central Sleep Apnea in Adults: An Interdisciplinary Approach to Diagnosis and Management-A Narrative Review

Abstract

Central sleep apnea (CSA) is a heterogeneous group of sleep-related breathing disorders characterized by intermittent absence of respiratory effort during sleep. CSA results from impaired neurological signaling from the respiratory centers to the respiratory muscles, leading to airflow cessation for at least 10 s. Major causes include heart failure, opioid use, central neurological disorders, and altitude exposure. This review outlines the pathophysiology of CSA, emphasizing ventilatory instability and brainstem dysfunction as key mechanisms. It details the classification of CSA subtypes, including Cheyne-Stokes respiration, high-altitude CSA, and drug-induced CSA. Clinical manifestations range from excessive daytime sleepiness to cardiovascular complications. Diagnostic approaches encompass polygraphy, polysomnography, and various laboratory tests to evaluate comorbidities. Treatment requires a multidisciplinary approach, addressing underlying conditions while utilizing positive airway pressure (PAP) therapy, adaptive servo-ventilation (ASV), supplemental oxygen, and pharmacological interventions. Newer modalities, such as phrenic nerve stimulation, offer promising outcomes for CSA management. This review underscores the necessity of an individualized, interdisciplinary strategy to improve patient outcomes in CSA.

Keywords: Cheyne-stokes Apnea; central sleep apnea; sleep apnea.

Figure 1

Complex sleep apnea syndrome/emergent CSA detection algorithm [1,15].

Figure 2

Central sleep apnea (polygraphy—Pulmonology Clinic Mureș). Absence of airflow, absence of respiratory movements of the chest and abdomen. CSA—central sleep apnea; SpO₂—blood oxygen saturation.