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Therapy for Sleep Hypoventilation and Central Apnea Syndromes

  • SLEEP DISORDERS (S CHOKROVERTY, SECTION EDITOR)
  • Published:
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Opinion statement

• Primary Central Sleep Apnea (CSA): We would recommend a trial of Positive Airway Pressure (PAP), acetazolamide, or zolpidem based on thorough consideration of risks and benefits and incorporation of patient preferences.

• Central Sleep Apnea Due to Cheyne-Stokes Breathing Pattern in Congestive Heart Failure (CSR-CHF): We would recommend PAP devices such as continuous positive airway pressure (CPAP) or adaptive servo-ventilation (ASV) to normalize sleep-disordered breathing after optimizing treatment of heart failure. Oxygen may also be an effective therapy. Acetazolamide and theophylline may be considered if PAP or oxygen is not effective.

• Central Sleep Apnea due to High-Altitude Periodic Breathing: We would recommend descent from altitude or supplemental oxygen. Acetazolamide may be used when descent or oxygen are not feasible, or in preparation for ascent to high altitude. Slow ascent may be preventative.

• Central Sleep Apnea due to Drug or Substance: If discontinuation or reduction of opiate dose is not feasible or effective, we would recommend a trial of CPAP, and if not successful, treatment with ASV. If ASV is ineffective or if nocturnal hypercapnia develops, bilevel positive airway pressure-spontaneous timed mode (BPAP-ST) is recommended.

• Obesity hypoventilation syndrome: We would recommend an initial CPAP trial. If hypoxia or hypercapnia persists on CPAP, BPAP, BPAP-ST or average volume assured pressure support (AVAPS™) is recommended. Tracheostomy with nocturnal ventilation should be considered when the above measures are not effective. Weight loss may be curative.

• Neuromuscular or chest wall disease: We would recommend early implementation of BPAP-ST based on thorough consideration of risks and benefits and patient preferences. AVAPS™ may also be considered. We recommend close follow up due to disease progression.

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Disclosure

Dr. Morgenthaler has served as secretary-treasurer of the American Academy of Sleep Medicine and has been the principal investigator for an investigator-initiated trial evaluating the treatment of complex sleep apnea syndrome funded by ResMed Corp.

Dr. Selim and Dr. Junna reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

  1. Mayo Clinic Center for Sleep Medicine, Rochester, MN, USA

    Bernardo J. Selim MD, Mithri R. Junna MD & Timothy I. Morgenthaler MD

  2. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Bernardo J. Selim MD & Timothy I. Morgenthaler MD

  3. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Mithri R. Junna MD

Authors
  1. Bernardo J. Selim MD
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  2. Mithri R. Junna MD
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  3. Timothy I. Morgenthaler MD
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Correspondence to Timothy I. Morgenthaler MD.

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Selim, B.J., Junna, M.R. & Morgenthaler, T.I. Therapy for Sleep Hypoventilation and Central Apnea Syndromes. Curr Treat Options Neurol 14, 427–437 (2012). https://doi.org/10.1007/s11940-012-0188-3

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  • DOI: https://doi.org/10.1007/s11940-012-0188-3

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