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Central Sleep Apnea in Adults: Diagnosis and Treatment - PubMed

Central Sleep Apnea in Adults: Diagnosis and Treatment

Dara D Regn et al. Fed Pract. 2023 Mar.

Abstract

Background: While the literature has demonstrated a higher prevalence of moderate-to-severe obstructive sleep apnea (OSA) in the general population compared with central sleep apnea (CSA), more evidence is needed on the long-term clinical impact of and optimal treatment strategies for CSA.

Observations: CSA is overrepresented among certain clinical populations, such as those with heart failure, stroke, neuromuscular disorders, and opioid use. The clinical concerns with CSA parallel those of OSA. The absence of respiration (apneas and hypopneas due to lack of effort) results in sympathetic surge, compromise of oxygenation and ventilation, sleep fragmentation, and elevation in blood pressure. Symptoms such as excessive daytime sleepiness, morning headaches, witnessed apneas, and nocturnal arrhythmias are shared between the 2 disorders. A systematic clinical approach should be used to identify and treat CSA.

Conclusions: The purpose of this review is to familiarize the primary care community with CSA to aid in the identification and management of this breathing disturbance.

Copyright © 2023 Frontline Medical Communications Inc., Parsippany, NJ, USA.

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Conflict of interest statement

Author disclosures The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.

Figures

FIGURE
FIGURE

CSA Diagnosis and Treatment Algorithm, Abbreviations: AHI, apnea hypopnea index; ASV, adaptive servo-ventilation; BiPAP, bilevel positive airway pressure; CPAP, continuous positive airway pressure; CSA, central sleep apnea; LVEF, left ventricular ejection fraction; NIV, noninvasive ventilation; OSA, obstructive sleep apnea. aEvaluation may include tests for thyroid function, arterial blood gas, and transthoracic echocardiogram. bScoring central vs obstructive hypopneas recommended.

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