Current Treatment Options in Neurology

, Volume 14, Issue 5, pp 427–437 | Cite as

Therapy for Sleep Hypoventilation and Central Apnea Syndromes

  • Bernardo J. Selim
  • Mithri R. Junna
  • Timothy I. Morgenthaler
SLEEP DISORDERS (S CHOKROVERTY, SECTION EDITOR)

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.

Keywords

Sleep hypoventilation Central apnea syndromes Alveolar hypoventilation syndromes Sleep-related hypoventilation syndromes Cheyne-Stokes breathing pattern High-altitude periodic breathing Drugs Narcotics Therapy 

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance

  1. 1.
    Wester IL. American Academy of Sleep Medicine. International classification of sleep-disorders, second edition: diagnostic and coding manual. American Academy of Sleep Medicine. 2005.Google Scholar
  2. 2.
    Quadri S, Drake C, Hudgel DW. Improvement of idiopathic central sleep apnea with zolpidem. J Clin Sleep Med. 2009;5:122–9.PubMedGoogle Scholar
  3. 3.••
    Aurora RN, Chowdhuri S, Ramar K, Bista SR, Casey KR, Lamm CI, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep. 2012;35:17–40. This article defines the most current practice parameters in the management of central sleep apnea syndrome in adults based on evidence-based literature review. It critically reviews pharmacological, positive pressure ventilation and surgical interventions when indicated.PubMedGoogle Scholar
  4. 4.
    Tamura A, Kawano Y, Kadota J. Carvedilol reduces the severity of central sleep apnea in chronic heart failure. Circulation. 2009;73:295–8.CrossRefGoogle Scholar
  5. 5.
    Oldenburg O, Bitter T, Lehmann R, Korte S, Dimitriadis Z, Faber L, et al. Adaptive servoventilation improves cardiac function and respiratory stability. Clin Res Cardiol. 2011;100:107–15.PubMedCrossRefGoogle Scholar
  6. 6.•
    Yoshihisa A, Shimizu T, Owada T, Nakamura Y, Iwaya S, Yamauchi H, et al. Adaptive servo ventilation improves cardiac dysfunction and prognosis in chronic heart failure patients with Cheyne-Stokes respiration. Int Heart J. 2011;52: 218–23. This study shows improvement of CSR in patients with chronic heart failure on adaptive servo ventilation, as well as improvement of functional status of heart failure, cardiac function and event free survival rate.PubMedCrossRefGoogle Scholar
  7. 7.
    Bitter T, Westerheide N, Faber L, Hering D, Prinz C, Langer C, et al. Adaptive servoventilation in diastolic heart failure and Cheyne-Stokes respiration. Eur Respir J. 2010;36:385–92.PubMedCrossRefGoogle Scholar
  8. 8.•
    Koyama T, Watanabe H, Kobukai Y, Makabe S, Munehisa Y, Iino K, et al. Beneficial effects of adaptive servo ventilation in patients with chronic heart failure. Circulation. 2010;74:2118–24. This article not only confirmed the improvement of nocturnal respiratory events (AHI) and cardiac function (LVEF) in patients with chronic heart failure on adaptive servo ventilation, but it also showed an anti-inflammatory effect in this population.CrossRefGoogle Scholar
  9. 9.
    Takama N, Kurabayashi M. Effectiveness of adaptive servo-ventilation for treating heart failure regardless of the severity of sleep-disordered breathing. Circulation. 2011;75:1164–9.CrossRefGoogle Scholar
  10. 10.
    Weng C, Chen Q, Ma Y, He Q. A meta-analysis of the effects of atrial overdrive pacing on sleep apnea syndrome. PACE Pacing Clin Electrophysiol. 2009;32:1434–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Lamba J, Simpson CS, Redfearn DP, Michael KA, Fitzpatrick M, Baranchuk A. Cardiac resynchronization therapy for the treatment of sleep apnoea: a meta-analysis. Europace. 2011;13:1174–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Luthje L, Renner B, Kessels R, Vollmann D, Raupach T, Gerritse B, et al. Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea. Eur J Heart Fail. 2009;11:273–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Toyama T, Seki R, Kasama S, Isobe N, Sakurai S, Adachi H, et al. Effectiveness of nocturnal home oxygen therapy to improve exercise capacity, cardiac function and cardiac sympathetic nerve activity in patients with chronic heart failure and central sleep apnea. Circ J. 2009;73:299–304.PubMedCrossRefGoogle Scholar
  14. 14.
    Sasayama S, Izumi T, Matsuzaki M, Matsumori A, Asanoi H, Momomura S-i, et al. Improvement of quality of life with nocturnal oxygen therapy in heart failure patients with central sleep apnea. Circulation. 2009;73:1255–62.CrossRefGoogle Scholar
  15. 15.
    Abe H, Takahashi M, Yaegashi H, Eda S, Kitahara H, Tsunemoto H, et al. Valve repair improves central sleep apnea in heart failure patients with valvular heart diseases. Circulation. 2009;73:2148–53.CrossRefGoogle Scholar
  16. 16.
    Javaheri S, Malik A, Smith J, Chung E. Adaptive pressure support servoventilation: a novel treatment for sleep apnea associated with use of opioids. J Clin Sleep Med. 2008;4:305–10.PubMedGoogle Scholar
  17. 17.
    Farney RJ, Walker JM, Boyle KM, Cloward TV, Shilling KC. Adaptive servoventilation (ASV) in patients with sleep disordered breathing associated with chronic opioid medications for non-malignant pain. J Clin Sleep Med. 2008;4:311–9.PubMedGoogle Scholar
  18. 18.•
    Radunovic A, Annane D, Jewitt K, Mustfa N. Mechanical ventilation for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev. 2009;4:CD004427. Evidence from a single randomised trial of non-invasive ventilation shows improvement in survival and quality of life in patients with ALS.Google Scholar
  19. 19.•
    Fitzgerald DA, Follett J, Van Asperen PP. The effect of supplemental oxygen on hypercapnia in subjects with obesity-associated hypoventilation: a randomized, crossover, clinical study. Chest. 2011;139:1018–24. This article contributes to current guidelines recommending the judicious use of oxygen in patients with obesity hypoventilation syndrome.PubMedCrossRefGoogle Scholar
  20. 20.
    Fitzgerald DA, Follett J, Van Asperen PP. Assessing and managing lung disease and sleep disordered breathing in children with cerebral palsy. Paediatr Respir Rev. 2009;10:18–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Katz SL, Gaboury I, Keilty K, Banwell B, Vajsar J, Anderson P, Ni A, MacLusky I Nocturnal hypoventilation: predictors and outcomes in childhood progressive neuromuscular disease. Arch Dis Child. 2010;95:998–1003.PubMedCrossRefGoogle Scholar
  22. 22.
    Piper AJ, Grunstein RR. Obesity hypoventilation syndrome: mechanisms and management. Am J Respir Crit Care Med. 2011;183:292–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Borel JC, Roux-Lombard P, Tamisier R, Arnaud C, Monneret D, Arnol N, et al. Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial. Chest. 2011;141:692–702.PubMedCrossRefGoogle Scholar
  24. 24.
    Priou P, Hamel JF, Person C, Meslier N, Racineux JL, Urban T, et al. Long-term outcome of noninvasive positive pressure ventilation for obesity hypoventilation syndrome. Chest. 2010;138:84–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Janssens JP, Metzger M, Sforza E. Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity-hypoventilation. Respir Med. 2009;103:165–72.PubMedCrossRefGoogle Scholar
  26. 26.
    Younes M, Ostrowski M, Thompson W, Leslie, C, Shewchuk, W. Chemical control stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2001;163:1181–90.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Bernardo J. Selim
    • 1
    • 2
  • Mithri R. Junna
    • 1
    • 3
  • Timothy I. Morgenthaler
    • 1
    • 2
  1. 1.Mayo Clinic Center for Sleep MedicineRochesterUSA
  2. 2.Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA
  3. 3.Department of NeurologyMayo ClinicRochesterUSA

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