Central sleep apnea is not a single disease entity, but rather includes several disorders in which the common abnormality is an absence of ‘signals’ from the brain, to the respiratory muscles which regulate breathing.
In some people, recurrent central sleep apneas during sleep are not associated with any apparent effects or physiologic disturbances. In others, they present with symptoms of morning fatigue, daytime sleepiness, morning headache, and recurrent nocturnal awakenings. One of the common form of central apnea is known as Cheyne-stokes respiration.
The Cheyne-srokes respiration is a pattern of breathing characterized by a waxing and waning in the breathing pattern with an associated fall in blood oxygen levels. This form of respiration is commonly seen in patients with congestive heart failure, being present in 30% to 40%. Its presence indicates a shorter survival compared to those who do not have this type of breathing.
Conditions that can cause central sleep apnea may also include degenerative disorders of the brain, and stroke affecting the brainstem. Other causes include complications of surgery of the cervical spine, severe arthritic and degenerative changes in the spine and/or base of skull.
Symptoms of Central Sleep Apnoea
People with primary sleep apnea of unknown cause may have frequent awakenings and complain of insomnia. If a neurological condition is causing the apnea, it may also produce other symptoms such as difficulty swallowing, change in voice, variable weakness or numbness throughout the body depending on the underlying disease and what parts of the nervous system it has affected.
If a neurological condition is causing the central apnoea, it may also produce other symptoms such as difficulty swallowing, change in voice, variable weakness, or numbness throughout the body, depending on the underlying disease and what parts of the nervous system it has affected.
Diagnosis
The diagnosis of Cheyne-Stokes respiration requires an overnight sleep study in a sleep laboratory. During the sleep investigation, breathing patterns, brain waves, oxygen levels, ECG and body movements are monitored.
Treatment
The first line of treatment is to optimize treatment is the cause of the central sleep apnoea is due to heart failure, by the addition of various drugs that will improve the function of the heart muscle. Among those with persistent central apnoea, various forms of continuous positive airways pressure (CPAP) and mechanical ventilation have also been used. The use of CPAP and related devices has been shown to improve cardiac function, quality of life and reduce the need for transplantation.
