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Treatment-Emergent Central Sleep Apnea

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Complex Sleep Breathing Disorders

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Abstract

Treatment-emergent central sleep apnea (TE-CSA) occurs when central sleep apneas and periodic breathing emerge with restoration of upper airway patency in individuals with obstructive sleep apnea (OSA). It is a non-rapid eye movement sleep process, driven by an overly sensitive ventilatory control system and sleep-wake instability superimposed on increased upper airway collapsibility. TE-CSA affects roughly 5–10% of OSA patients treated with continuous positive airway pressure (CPAP) and is associated with conditions that predispose to central sleep apnea including heart failure, atrial fibrillation, and opioid use. The trajectories of TE-CSA vary, with resolution occurring in about 50%, persistence in 25%, and late development (weeks after CPAP initiation) in another 25%. Since TE-CSA resolves in a majority, close observation on CPAP may be attempted. However, TE-CSA is associated with poor adherence and CPAP use termination with ongoing poor quality of life and symptoms. This can be addressed by tailoring therapy early with treatments such as adaptive servo-ventilation. Because of the multifactorial nature of TE-CSA pathogenesis, optimal treatment may require multi-modality therapy targeting ventilatory and sleep state instability, including oxygen, carbonic anhydrase inhibitors, or sedative hypnotics. Patient-oriented clinical research in treatment of TE-CSA is needed before such approaches can be incorporated into clinical care.

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Authors and Affiliations

  1. Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA

    Andrey Zinchuk & Henry Klar Yaggi

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  1. Andrey Zinchuk
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  2. Henry Klar Yaggi
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Correspondence to Andrey Zinchuk .

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Editors and Affiliations

  1. Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA

    Christine Won

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Zinchuk, A., Yaggi, H.K. (2021). Treatment-Emergent Central Sleep Apnea. In: Won, C. (eds) Complex Sleep Breathing Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-57942-5_8

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  • DOI: https://doi.org/10.1007/978-3-030-57942-5_8

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