Central Sleep Apnea

As part 3 of the three chapters on sleep-disordered breathing, this chapter reviews central sleep apnea (CSA). CSA is defined as recurrent apneic events during sleep in the absence of respiratory muscle effort and loss of neuronal output to respiratory muscles. The most common cause of CSA is compromised cardiac function. In patients with CSA whose ejection fraction is less than or equal to 45%, adaptive servo-ventilation (ASV) has been shown to increase mortality. With the abuse of opioids reaching epidemic proportions, it has been estimated that 30 to 75% of patients on chronic opioid therapy have a significant increased incidence of CSA. Opioid-induced sleep-disordered breathing can be treated with ASV. This review contains 1 figure, and 37 references. Key Words: adaptive servo-ventilation, central sleep apnea, Cheyne-Stokes respiration, congenital central hypoventilation syndrome, impaired central ventilatory drive, opioid abuse, PHOX2B gene, supplemental oxygen