Therapy for Sleep Hypoventilation and Central Apnea Syndromes
- Bernardo J. SelimAffiliated withMayo Clinic Center for Sleep MedicineDivision of Pulmonary and Critical Care Medicine, Mayo Clinic
- , Mithri R. JunnaAffiliated withMayo Clinic Center for Sleep MedicineDepartment of Neurology, Mayo Clinic
- , Timothy I. MorgenthalerAffiliated withMayo Clinic Center for Sleep MedicineDivision of Pulmonary and Critical Care Medicine, Mayo Clinic Email author
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• 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.
KeywordsSleep hypoventilation Central apnea syndromes Alveolar hypoventilation syndromes Sleep-related hypoventilation syndromes Cheyne-Stokes breathing pattern High-altitude periodic breathing Drugs Narcotics Therapy
- Therapy for Sleep Hypoventilation and Central Apnea Syndromes
Current Treatment Options in Neurology
Volume 14, Issue 5 , pp 427-437
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
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- Sleep hypoventilation
- Central apnea syndromes
- Alveolar hypoventilation syndromes
- Sleep-related hypoventilation syndromes
- Cheyne-Stokes breathing pattern
- High-altitude periodic breathing
- Industry Sectors
- Author Affiliations
- 1. Mayo Clinic Center for Sleep Medicine, Rochester, MN, USA
- 2. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- 3. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA