Central night apnea
Last reviewed: 23.04.2024
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Central nocturnal sleep apnea (sleep apnea) is a heterogeneous group of conditions characterized by changes in the respiratory center or a decrease in the ability to breathe without the development of airway obstruction; most of these conditions cause asymptomatic changes in the structure of breathing during sleep.
[What causes central nocturnal sleep apnea?
Patients with central sleep apnea (CAC) fall into two categories. One group has hypercapnia with a decrease in the activity of the respiratory center or a decreased ability to breathe. Causes include central lesions, such as cerebral infarction, encephalitis and Arnold-Chiari defect; neuromuscular diseases, such as muscular dystrophy, amyotrophic lateral sclerosis, and post-poliomyelitis syndrome; and lesions of the chest wall, especially kyphoscoliosis. The other group has normocapnia or hypocapnia with increased activity of the respiratory center, but caused by sleep apnea and periodic breathing. The Cheyne-Stokes breathing is a special form of such a central nocturnal apnea, which is caused by disorders of the cerebral circulation, which in turn cause a delay in the recognition by the respiratory centers of acidosis / hypoxia (due to hyperpnoea) and alkalosis / hypocapnia (due to apnea). The causes of central nocturnal sleep apnea include heart failure, high altitude, pain and anxiety.
Congenital central hypoventilation (Ondine's disease) is a rare variant of idiopathic central nocturnal apnea in newborns, it can be associated with Hirschsprung's disease or associated with a congenital anomaly of the development of the nervous system.
Symptoms of central nocturnal sleep apnea
Central nocturnal apnea is in most cases asymptomatic and is detected by attendants or co-sleeping people who notice prolonged respiratory pauses, shallow breathing, or restless sleep. Patients with hypercapnic forms can experience daytime drowsiness, lethargy and morning headache.
Diagnosis of central nocturnal sleep apnea
The diagnosis of "central nocturnal sleep apnea" is suspected anamnestic and is confirmed by a polysomnographic study. The study may not be necessary, especially if central nocturnal sleep apnea does not cause symptoms or is clearly associated with a particular disease. Additional studies may include examinations of the brain or its trunk to identify central causes.
Treatment of central nocturnal sleep apnea
Primary treatment of central nocturnal apnea is aimed at correcting causal conditions and preventing the use of sedatives. Secondary treatment consists in the appointment of additional O 2 or, in patients with hypercapnic forms of central nocturnal apnea, a noninvasive long-lasting bi-level positive pressure in the airways. Acetazolamide is effective in central nighttime sleep apnea, caused by staying at high altitude. Stimulation of the diaphragmatic nerve is the method of choice for children older than 2 years with congenital forms of central nocturnal apnea.