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Central nocturnal apnea
Last reviewed: 05.07.2025
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Central sleep apnea (sleep apnea) is a heterogeneous group of conditions characterized by changes in respiratory drive or decreased ability to breathe without developing airway obstruction; most of these conditions cause asymptomatic changes in breathing patterns during sleep.
[ What causes central sleep apnea?
Patients with central sleep apnea (CSA) fall into two categories. One group has hypercapnia with decreased respiratory drive or decreased ability to breathe. Causes include central lesions such as brainstem infarctions, encephalitis, and Arnold-Chiari malformation; neuromuscular diseases such as muscular dystrophy, amyotrophic lateral sclerosis, and postpolio syndrome; and chest wall lesions, especially kyphoscoliosis. The other group has normocapnia or hypocapnia with increased respiratory drive but sleep-induced apnea and periodic breathing. Cheyne-Stokes respiration is a special form of central sleep apnea that is caused by disturbances in cerebral circulation, which in turn cause a delay in the respiratory centers recognizing acidosis/hypoxia (due to hyperpnea) and alkalosis/hypocapnia (due to apnea). Causes of central sleep apnea include heart failure, high altitude, pain, and anxiety.
Congenital central hypoventilation (Ondin disease) is a rare variant of idiopathic central sleep apnea in newborns; it may be associated with Hirschsprung disease or associated with a congenital anomaly in the development of the nervous system.
Symptoms of Central Sleep Apnea
Central sleep apnea is usually asymptomatic and is detected by caregivers or co-sleepers who notice prolonged pauses in breathing, shallow breathing, or restless sleep. Patients with hypercapnic forms may experience daytime sleepiness, lethargy, and morning headache.
Diagnosis of central sleep apnea
The diagnosis of central sleep apnea is suspected by history and confirmed by polysomnographic testing. Testing may not be necessary, especially if central sleep apnea is asymptomatic or clearly associated with a specific disorder. Additional testing may include brain or brainstem imaging to identify central causes.
Treatment of central sleep apnea
Primary treatment of central sleep apnea is aimed at correcting the underlying conditions and avoiding the use of sedatives. Secondary treatment consists of supplemental O2 or, in patients with hypercapnic forms of central sleep apnea, noninvasive continuous bilevel positive airway pressure. Acetazolamide is effective in central sleep apnea due to high altitude. Phrenic nerve stimulation is the treatment of choice for children over 2 years of age with congenital forms of central sleep apnea.