Diagnosis and management of central sleep apnea syndrome

Expert Rev Respir Med. 2019 Jun;13(6):545-557. doi: 10.1080/17476348.2019.1604226. Epub 2019 Apr 24.


Introduction: Central sleep apnea (CSA) syndrome has gained a considerable interest in the sleep field within the last 10 years. It is overrepresented in particular subpopulations such as patients with stroke or heart failure. Early detection and diagnosis, as well as appropriate treatment of central breathing disturbances during sleep remain challenging. Areas covered: Based on a systematic review of CSA in adults the clinical evidence and polysomnographic patterns useful for discerning central from obstructive events are discussed. Current therapeutic indications of CSA and perspectives are presented, according to the type of respiratory disturbances during sleep, alterations in blood gases and ventilatory control. Expert opinion: The precise identification of central events during polysomnographic recording is mandatory. Therapeutic choices for CSA depend on the typology of respiratory disturbances observed by polysomnography, changes in blood gases and ventilatory control. In CSA with normocapnia and ventilatory instability, adaptive servo-ventilation is recommended. In CSA with hypercapnia and/or rapid-eye movement sleep hypoventilation, non-invasive ventilation is required. Further studies are required as strong evidence is lacking regarding the long-term consequences of CSA and the long-term impact of current treatment strategies.

Keywords: Central sleep apnea; adaptive servo-ventilation; heart failure; intermittent hypoxia; polysomnography; prognosis; stroke; ventilatory control.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Disease Management*
  • Heart Failure / complications
  • Humans
  • Hypercapnia
  • Hypoventilation
  • Polysomnography
  • Practice Guidelines as Topic
  • Sleep Apnea, Central / diagnosis*
  • Sleep Apnea, Central / etiology
  • Sleep Apnea, Central / physiopathology
  • Sleep Apnea, Central / therapy
  • Stroke / complications