Materiały źródłowe

• #1 Central Sleep Apnea: a Brief Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6883649/

  The purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis and treatment, including areas of controversy and uncertainty. […] Management strategy for central apnea aim to eliminate abnormal respiratory events, stabilize sleep and alleviate the underlying clinical condition. Positive pressure therapy (PAP) remains a standard therapy for central as well as obstructive apnea. Other treatment options include adaptive-servo ventilation (ASV), supplemental oxygen, phrenic nerve stimulation, and pharmacologic therapy. However, ASV is contraindicated in patients with central sleep apnea who had heart failure with reduced ejection fraction, owing to increased mortality in this population. […] There are several therapeutic options for central apnea. Randomized controlled studies are needed to ascertain the long-term effectiveness of individual, or combination, treatment modalities in different types of central apnea.

• #2 Central Sleep Apnea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK578199/

  Central sleep apnea can result from heart failure, stroke, high altitude. This activity reviews pathophysiology and diagnostic and therapeutic modalities available for managing central sleep apnea and highlights the interprofessional team’s role in managing the condition better. […] Explain different treatment modalities available for patients with central sleep apnea. […] The primary goals in CSA management are to stabilize sleep by suppressing abnormal respiratory events and optimizing the treatment of comorbid conditions. Positive airway pressure (PAP) remains a standard treatment for both central and obstructive apnea that can be delivered as continuous PAP (CPAP), Bi-level PAP therapy (BPAP), and adaptive servo-ventilation (ASV). Apart from PAP devices, additional therapeutic options include supplemental Oxygen, carbon dioxide, and pharmacologic agents. A longitudinal study demonstrated that CPAP and BPAP are more effective for CSA management in HF and opioid use.

• #3 Central sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

  A primary care professional might evaluate your condition based on your symptoms. […] A sleep specialist can help you decide on your need for further evaluation. That might involve overnight monitoring of your breathing and other body functions during a sleep study called polysomnography. […] In a split-night sleep study, you’re monitored during the first half of the night. If you’re diagnosed with central sleep apnea, staff might wake you to start a therapy for the second half of the night. The therapy might be positive airway pressure or supplemental oxygen. […] Polysomnography can help diagnose central sleep apnea. It also can help rule out other sleep disorders, such as obstructive sleep apnea, repetitive movements during sleep or narcolepsy. […] To address central sleep apnea, a health care professional may recommend a positive airway pressure machine. Positive airway pressure devices used for central sleep apnea include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BPAP) and adaptive servo-ventilation (ASV). These devices deliver pressurized air through a tight-sealing mask to help support breathing.

• #4 Central sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

  A primary care professional might evaluate your condition based on your symptoms. […] A sleep specialist can help you decide on your need for further evaluation. That might involve overnight monitoring of your breathing and other body functions during a sleep study called polysomnography. […] In a split-night sleep study, you’re monitored during the first half of the night. If you’re diagnosed with central sleep apnea, staff might wake you to start a therapy for the second half of the night. The therapy might be positive airway pressure or supplemental oxygen. […] Polysomnography can help diagnose central sleep apnea. It also can help rule out other sleep disorders, such as obstructive sleep apnea, repetitive movements during sleep or narcolepsy. […] To address central sleep apnea, a health care professional may recommend a positive airway pressure machine. Positive airway pressure devices used for central sleep apnea include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BPAP) and adaptive servo-ventilation (ASV). These devices deliver pressurized air through a tight-sealing mask to help support breathing.

• #5 Central Sleep Apnea Syndromes Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/304967-treatment

  No clear guidelines are available on when or whether to treat central sleep apnea in the absence of symptoms, particularly when central sleep apnea is discovered after polysomnography (PSG) is performed for another reason. Clearly, when the symptoms are present, treatment is warranted. The decision to treat should be made on an individual basis. […] Up to 20% of central sleep apnea cases resolve spontaneously. If the patient is not symptomatic, observation may be the only appropriate step. This may be the case in patients who have central sleep apnea during sleep-wake transition, patients without significant oxygen desaturation, or in those who experience central sleep apnea during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea. […] If present, treatment of the underlying disorder often improves central sleep apnea. For example, descending to a low altitude is effective in treating high-altitude periodic breathing. Similarly, instituting nocturnal dialysis and optimizing medical treatment are often effective for Cheyne-Stokes breathing-central sleep apnea (CSB-CSA) due to renal failure and heart failure, respectively. Heart transplantation has also been reported either to resolve CSB-CSA or to decrease the cycle length of CSB-CSA breathing.

• #6 Central sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

  Treatments for central sleep apnea might include: Addressing associated medical problems. Possible causes of central sleep apnea include other disorders. Treating those conditions might help your central sleep apnea. For example, therapy for heart failure might improve central sleep apnea. […] Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over the nose or over the nose and mouth while asleep. […] The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open the upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea. […] Adaptive servo-ventilation (ASV). If CPAP doesn’t effectively treat your condition, you might be given ASV. Like CPAP, ASV also delivers pressurized air.

• #7 Central Sleep Apnea Syndromes Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/304967-treatment

  No clear guidelines are available on when or whether to treat central sleep apnea in the absence of symptoms, particularly when central sleep apnea is discovered after polysomnography (PSG) is performed for another reason. Clearly, when the symptoms are present, treatment is warranted. The decision to treat should be made on an individual basis. […] Up to 20% of central sleep apnea cases resolve spontaneously. If the patient is not symptomatic, observation may be the only appropriate step. This may be the case in patients who have central sleep apnea during sleep-wake transition, patients without significant oxygen desaturation, or in those who experience central sleep apnea during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea. […] If present, treatment of the underlying disorder often improves central sleep apnea. For example, descending to a low altitude is effective in treating high-altitude periodic breathing. Similarly, instituting nocturnal dialysis and optimizing medical treatment are often effective for Cheyne-Stokes breathing-central sleep apnea (CSB-CSA) due to renal failure and heart failure, respectively. Heart transplantation has also been reported either to resolve CSB-CSA or to decrease the cycle length of CSB-CSA breathing.

• #8 Central sleep apnea: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003997.htm

  Treating the condition that is causing central sleep apnea can help manage symptoms. For example, if central sleep apnea is due to heart failure, the goal is to treat the heart failure itself. […] Devices used during sleep to aid breathing may be recommended. These include nasal continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) or adaptive servo-ventilation (ASV). Some types of central sleep apnea are treated with medicines that stimulate breathing. […] Oxygen treatment may help ensure the lungs get enough oxygen while sleeping. […] If narcotic medicine is causing the apnea, the dosage may need to be lowered or the medicine changed. […] The FDA has approved a medical device (remede System) to treat central sleep apnea. The device is implanted in the chest. When a breathing pause is detected, the device stimulates the nerve that controls the breathing muscles so that you will breathe.

• #9 Central Sleep Apnea Syndromes Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/304967-treatment

  No clear guidelines are available on when or whether to treat central sleep apnea in the absence of symptoms, particularly when central sleep apnea is discovered after polysomnography (PSG) is performed for another reason. Clearly, when the symptoms are present, treatment is warranted. The decision to treat should be made on an individual basis. […] Up to 20% of central sleep apnea cases resolve spontaneously. If the patient is not symptomatic, observation may be the only appropriate step. This may be the case in patients who have central sleep apnea during sleep-wake transition, patients without significant oxygen desaturation, or in those who experience central sleep apnea during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea. […] If present, treatment of the underlying disorder often improves central sleep apnea. For example, descending to a low altitude is effective in treating high-altitude periodic breathing. Similarly, instituting nocturnal dialysis and optimizing medical treatment are often effective for Cheyne-Stokes breathing-central sleep apnea (CSB-CSA) due to renal failure and heart failure, respectively. Heart transplantation has also been reported either to resolve CSB-CSA or to decrease the cycle length of CSB-CSA breathing.

• #10 Central Sleep Apnea – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/central-sleep-apnea

  Treatment of underlying disorders […] Primary treatment of symptomatic central sleep apnea is often optimal management of underlying disorders (eg, heart failure) and avoidance or reduction of opioids, alcohol, and other sedatives. […] Secondary treatment of patients with symptomatic CSA can be a trial of supplemental oxygen or respiratory stimulants. Other patients may use positive airway pressure or other devices, depending on the underlying disorder. […] For patients who have CSA and Cheyne-Stokes breathing despite optimization of cardiac function, supplemental oxygen may decrease apneic and hypopneic episodes. Similarly, continuous positive airway pressure (CPAP) can sometimes be effective in treating heart failure and Cheyne-Stokes breathing by decreasing hypoxemia and reducing preload and afterload.

• #11 Central Sleep Apnea: Causes, Symptoms, and Treatments

  https://www.webmd.com/sleep-disorders/sleep-apnea/central-sleep-apnea

  Treatment might depend on the cause of your apnea and might involve taking medicine for heart failure or stopping an opioid medication. […] Continuous positive airway pressure (CPAP) can help people with all kinds of sleep apnea, especially CSA caused by heart failure. […] A device called the Remede System can help with moderate to severe central sleep apnea. Your doctor implants a small machine under the skin in your upper chest. It helps trigger the nerve that moves your diaphragm when you breathe. It also monitors your respiratory signals while you sleep and helps restore regular breathing patterns. […] Medications like acetazolamide (Diamox) and theophylline (Theochron) can stimulate breathing.

• #12 Central sleep apnea: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003997.htm

  Treating the condition that is causing central sleep apnea can help manage symptoms. For example, if central sleep apnea is due to heart failure, the goal is to treat the heart failure itself. […] Devices used during sleep to aid breathing may be recommended. These include nasal continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) or adaptive servo-ventilation (ASV). Some types of central sleep apnea are treated with medicines that stimulate breathing. […] Oxygen treatment may help ensure the lungs get enough oxygen while sleeping. […] If narcotic medicine is causing the apnea, the dosage may need to be lowered or the medicine changed. […] The FDA has approved a medical device (remede System) to treat central sleep apnea. The device is implanted in the chest. When a breathing pause is detected, the device stimulates the nerve that controls the breathing muscles so that you will breathe.

• #13 Central sleep apnea | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/central-sleep-apnea

  Treatments for central sleep apnea might involve managing existing conditions, using a device to assist breathing or using supplemental oxygen. […] Treatments for central sleep apnea might include: […] Addressing associated medical problems. Possible causes of central sleep apnea include other disorders. Treating those conditions might help your central sleep apnea. For example, therapy for heart failure might improve central sleep apnea. […] Reduction of opioid medicines. If opioid medicines are causing your central sleep apnea, your health care team might reduce your dose of those medicines over time. […] Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over the nose or over the nose and mouth while asleep. The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open the upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea.

• #14 Central Sleep Apnea and Mental Health

  https://www.verywellmind.com/central-sleep-apnea-and-mental-health-5222050

  Learn how central sleep apnea occurs, why its so closely tied to mental health, and how to build a treatment plan for a comorbid sleep and mental health disorder. […] If you want to improve your nighttime breathing, Dr. Dimitriu suggests avoiding alcohol, maintaining a healthy weight, and managing your allergies, if you have them. […] For a central sleep apnea diagnosis, you may be referred to an ear, throat, or nose doctor, as well as a cardiologist. […] Some of the most common treatments for central sleep apnea include: Continuous positive airway pressure (CPAP) therapy, Adaptive servo-ventilation (ASV) device, Bilevel positive airway pressure (BPAP) device, Medication such as acetazolamide or theophylline, Remed system, which is implanted under the skin and helps regulate breathing. […] Opioids predispose you to central sleep apnea, so if youre on chronic opioid therapy and experiencing central sleep apnea or another form of sleep-disordered breathing, you may need to consider alternative medication or work with your doctor to treat the sleep disorder.

• #15 Central sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

  A primary care professional might evaluate your condition based on your symptoms. […] A sleep specialist can help you decide on your need for further evaluation. That might involve overnight monitoring of your breathing and other body functions during a sleep study called polysomnography. […] In a split-night sleep study, you’re monitored during the first half of the night. If you’re diagnosed with central sleep apnea, staff might wake you to start a therapy for the second half of the night. The therapy might be positive airway pressure or supplemental oxygen. […] Polysomnography can help diagnose central sleep apnea. It also can help rule out other sleep disorders, such as obstructive sleep apnea, repetitive movements during sleep or narcolepsy. […] To address central sleep apnea, a health care professional may recommend a positive airway pressure machine. Positive airway pressure devices used for central sleep apnea include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BPAP) and adaptive servo-ventilation (ASV). These devices deliver pressurized air through a tight-sealing mask to help support breathing.

• #16 Central Sleep Apnea: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/central-sleep-apnea

  Central sleep apnea may be a complication of another medical issue. Healthcare providers often treat it with pressurized air pressure systems that manage breathing. […] Healthcare providers treat central sleep apnea with positive air pressure (PAP) systems that prevent sleep apnea symptoms. PAP systems include: Continuous positive air pressure (CPAP) machines, Bilevel positive air pressure (BiPAP) machines, Adaptive servo-ventilation (ASV) machines. […] Healthcare providers have treatments to help manage central sleep apnea so you can have more peaceful nights and wake up feeling refreshed and ready to take on your day.

• #17 Central sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

  Treatments for central sleep apnea might include: Addressing associated medical problems. Possible causes of central sleep apnea include other disorders. Treating those conditions might help your central sleep apnea. For example, therapy for heart failure might improve central sleep apnea. […] Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over the nose or over the nose and mouth while asleep. […] The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open the upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea. […] Adaptive servo-ventilation (ASV). If CPAP doesn’t effectively treat your condition, you might be given ASV. Like CPAP, ASV also delivers pressurized air.

• #18 Central Sleep Apnea: a Brief Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6883649/

  Optimal treatment of concomitant clinical conditions is a critical first step, which may result in amelioration of the severity of central apnea. Positive pressure therapy could be delivered as continuous positive airway pressure (CPAP), bi-level pressure (B-PAP) or Adaptive servo ventilation (ASV). CPAP is the recommended treatment first line therapy for central apnea with about 50% response rate. […] The development of central apnea may be mitigated by altering the mode of delivering positive pressure therapy. Specifically, Adaptive Servo Ventilation (ASV) provides varying amount of ventilatory support, against a background of positive end expiratory pressure (EPAP). […] Stimulation of the phrenic nerve is a physiologically appealing intervention that may be an option for patients with central apnea. A new commercially available implantable phrenic nerve stimulator that provides unilateral stimulation of the phrenic nerve has been recently approved by the FDA for the treatment of moderate to severe central sleep apnea (CSA) in adult patients. Approval was based on a randomized clinical trial demonstrating improvement in central apnea indices, oxygenation, sleep metrics and quality of life. Phrenic nerve stimulation appears to be a promising therapeutic approach for central sleep apnea.

• #19 Central Sleep Apnea: Symptoms, Causes, Treatments, and More

  https://resources.healthgrades.com/right-care/sleep-disorders/central-sleep-apnea

  Central sleep apnea occurs when your brain is unable to send effective signals to the muscles involved in breathing. […] Positive airway pressure (PAP) is a standard treatment for central sleep apnea. This can include: continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), adaptive servo-ventilation (ASV). […] CPAP is the first-line treatment for central sleep apnea, with a response rate of around 50%. […] Treatments for central sleep apnea focus on stabilizing breathing and managing underlying health conditions. […] Either alongside or instead of positive airway pressure (PAP), treatments can include: phrenic nerve stimulation, supplemental oxygen, certain medications. […] In 2017, the Food and Drug Administration (FDA) approved the Remedē System device for people with moderate to severe central sleep apnea.

• #20 M. Safwan Badr, MD: What are the Novel Treatments for Central Sleep Apnea?

  https://www.hcplive.com/view/m-safwan-badr-md-what-are-the-novel-treatments-for-central-sleep-apnea-

  At SLEEP 2024, Badr presented on novel treatments for central sleep apnea like phrenic nerve stimulation. […] Effective traditional treatments exist for CSA, like positive airway pressure therapy, supplemental oxygen, and adaptive servo ventilation. Continuous positive airway pressure (CPAP) is a first line therapy and helps 50% to 60% of individuals with CSA. Novel treatments for CSA include phrenic nerve stimulation and pharmacological therapy. […] I would envision that many future interventions will involve CPAP plus another interventionbecause if you correct the central apnea but leave the obstructive apnea untouched, we haven’t helped you, Badr said. For the two thirds of the patients who have both, it will probably be treatment of both conditions.

• #21 Central sleep apnea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/symptoms-causes/syc-20352109

  Central sleep apnea can result from other conditions, such as heart failure and stroke. Another possible cause is sleeping at a high altitude. […] Treatments for central sleep apnea might involve managing existing conditions, using a device to assist breathing or using supplemental oxygen. […] Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for treatment. This condition is known as treatment-emergent central sleep apnea. It is a combination of obstructive and central sleep apneas. […] For some people, complex sleep apnea goes away with continued use of their CPAP device. Other people may be treated with a different kind of positive airway pressure therapy. […] Central sleep apnea is a serious medical condition. Some complications include: […] Cardiovascular problems. Sudden drops in blood oxygen levels that occur during central sleep apnea can affect heart health.

• #22 Treatment-emergent central sleep apnea – UpToDate

  https://www.uptodate.com/contents/treatment-emergent-central-sleep-apnea

  Treatment-emergent central sleep apnea (CSA), previously referred to as complex sleep apnea, is detected in approximately 5 to 15 percent of patients who undergo positive airway pressure (PAP) titration for obstructive sleep apnea (OSA). […] In more than half of cases, treatment-emergent CSA is a transient phenomenon that resolves within the first few months of PAP. Less commonly, the abnormality is persistent and requires a change in mode of ventilation. […] The epidemiology, pathogenesis, clinical presentation, clinical findings, diagnostic criteria, and management of treatment-emergent CSA are reviewed here. […] The diagnosis and management of OSA and central sleep apnea are described separately. […] Risk factors for treatment-emergent central sleep apnea (CSA) are not well understood, and there is wide variability in the reported incidence depending upon the study and the population.

• #23 Emergent central sleep apnea during CPAP therapy-clinical implications – Mador – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/16430/html

  CPAP emergent central sleep apnea (CSA) (classified as treatment emergent CSA) is a well-recognized phenomenon that has been included in the current edition of the International Classification of Sleep Disorders. It is defined as the presence of primarily obstructive sleep apnea (OSA) on the diagnostic sleep study, significant resolution of obstructive events with CPAP titration but emergence or persistence of central events during PAP treatment with a central apnea index (CAI) 5/hr and greater than 50% of events being central and the results cannot be better explained by another CSA disorder. […] CPAP emergent CSA usually resolves over time. However, it can also persist over time (defined as CPAP persistent CSA) and can develop later in the course of PAP treatment despite being absent during the initial diagnostic sleep study (defined as emergent CSA). […] In this regard ASV is superior to other modalities for treatment of CPAP emergent CSA.

• #24 Central Sleep Apnea Syndromes Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/304967-treatment

  Several different treatments aimed at central sleep apnea include positive airway pressure, adaptive servo ventilation (ASV), oxygen, added dead space, carbon dioxide inhalation, and overdrive atrial pacing. […] CPAP improves cardiac function in patients with congestive heart failure and CSB-CSA. […] Bilevel positive airway pressure (BIPAP) is effective for treating patients with hypercapnic central sleep apnea (associated with hypoventilation). […] Some patients with nonhypercapnic central sleep apnea, such as CSB-CSA, and primary central sleep apnea have been shown to benefit from BIPAP. […] Added dead space by attaching a plastic cylinder of variable volume (400-800 mL) to a tightly fitting mask can act as a source of increased carbon dioxide concentration in the inspired air and can increase the carbon dioxide reserves above the apneic threshold.

• #25 Central Sleep Apnea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK578199/

  CPAP; has been recommended as the first-line therapy for CSA. Available literature and data support CPAP’s beneficial effect on CSA. […] BPAP; It can be a viable option in hypercapnic CSA, especially if the patient is unresponsive to CPAP. […] ASV; is a form of PAP that provides ventilatory support individualized to the patient’s effort. […] Nocturnal oxygen therapy in previous trials has decreased the number of apneic episodes during sleep times for patients with CHF. […] Unilateral placement of phrenic nerve stimulators is another treatment option for patients with central sleep apnea. […] Different pharmacological agents have been studied as a potential treatment for central sleep apnea. However, these medications remain investigational, and there is no approved pharmacological treatment for CSA.

• #26 Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p968.html

  CPAP therapy targeted to normalize the apnea-hypopnea index is indicated for the initial treatment of central sleep apnea syndromes related to congestive heart failure (CHF). (Standard.) […] Bilevel positive airway pressure therapy in a spontaneous timed mode targeted to normalize the apnea-hypopnea index may be considered for the treatment of central sleep apnea related to CHF only if there is no response to adequate trials of CPAP, adaptive servo-ventilation, and oxygen therapies. (Option.) […] Adaptive servo-ventilation targeted to normalize the apnea-hypopnea index is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Nocturnal oxygen therapy is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Acetazolamide and theophylline have limited supporting evidence, but may be considered for the treatment of central sleep apnea syndromes related to CHF after optimization of standard medical therapy, if positive airway pressure is not tolerated and if accompanied by close clinical follow-up. (Option.) […] The following possible treatment options for central sleep apnea syndromes related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (Option.)

• #27 Complex Sleep Apnea: Causes & Treatment | SleepApnea.org

  https://www.sleepapnea.org/complex-mixed-sleep-apnea/?srsltid=AfmBOooS7_EEuwuwAQQJKb7UWFqBrJCVPOr81rNoCHzkvocn117xdxcc

  Complex sleep apnea can develop when a person is receiving treatment for obstructive sleep apnea. […] Most cases of complex sleep apnea resolve over time. Therefore, a doctor may recommend continuing CPAP therapy and monitoring a person’s progress, rather than immediately changing the treatment plan. […] If repeat testing confirms the presence of complex sleep apnea, the healthcare provider may recommend adjusting treatment by switching to ASV or BiPAP with a back-up rate. […] Adaptive servo-ventilation may be recommended to treat persistent complex sleep apnea. ASV uses specialized technology to monitor a person’s breathing and adjust the pressure as needed. […] If ASV is not an appropriate option, a doctor may recommend treating persistent complex sleep apnea with a BiPAP machine. A BiPAP machine works by delivering two different levels of air pressure during sleep. […] BiPAP treatment for complex sleep apnea uses a backup rate. The back-up rate is a safety feature that provides a set number of breaths per minute when a person is not breathing adequately on their own.

• #28 Central sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

  Treatments for central sleep apnea might include: Addressing associated medical problems. Possible causes of central sleep apnea include other disorders. Treating those conditions might help your central sleep apnea. For example, therapy for heart failure might improve central sleep apnea. […] Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over the nose or over the nose and mouth while asleep. […] The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open the upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea. […] Adaptive servo-ventilation (ASV). If CPAP doesn’t effectively treat your condition, you might be given ASV. Like CPAP, ASV also delivers pressurized air.

• #29 Central Sleep Apnoea (CSA) treatment options | ResMed

  https://me.resmed.com/professionals/sleep-apnoea/treatment-options-for-csa/

  ASV is a form of PAP therapy that delivers auto-adjusting pressure support with automatic pressure support and expiratory positive airway pressure. ASV helps to treat both obstructive and central respiratory events and maintains adequate ventilation in response to patients changing needs. […] Compared to other forms of PAP therapy, ASV offers significant benefits for the treatment of central sleep-disordered breathing. This has been demonstrated in multiple clinical trials across various patient types. […] Compared to other forms of PAP therapy, ASV can offer significant benefits for the treatment of central SDB. This has been demonstrated in multiple clinical trials across various patient types.

• #30 Central Sleep Apnea Syndromes Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/304967-treatment

  ASV is used for treatment for CSA, especially CSB-CSA. […] Studies demonstrate that ASV is superior to conventional positive airway pressure therapy for controlling the number of central sleep apneas, improving sleep architecture and daytime hypersomnolence, particularly for CSB-CSA, central sleep apnea syndrome, and complex sleep apnea. […] Supplemental oxygen may be effective in some patients with CSB-CSA due to heart failure and has also been shown to improve ejection fraction. […] Overdrive atrial pacing has been shown to reduce both obstructive and central apneas in patients with sleep-disordered breathing who have dual-chamber pacemakers. […] In October 2017, the US Food and Drug Administration (FDA) approved an implantable device for the treatment of central sleep apnea. […] Self-report questionnaires following 12 months of usage of TPNS therapy reported significant improvements of symptoms with 45% of patients indicating cessation of daytime sleepiness, 44% cessation of fatigue/weakness, and 52% no longer having difficulty falling/staying asleep.

• #31 Central Sleep Apnoea (CSA) treatment options | ResMed

  https://me.resmed.com/professionals/sleep-apnoea/treatment-options-for-csa/

  ASV is a form of PAP therapy that delivers auto-adjusting pressure support with automatic pressure support and expiratory positive airway pressure. ASV helps to treat both obstructive and central respiratory events and maintains adequate ventilation in response to patients changing needs. […] Compared to other forms of PAP therapy, ASV offers significant benefits for the treatment of central sleep-disordered breathing. This has been demonstrated in multiple clinical trials across various patient types. […] Compared to other forms of PAP therapy, ASV can offer significant benefits for the treatment of central SDB. This has been demonstrated in multiple clinical trials across various patient types.

• #32 Central Sleep Apnea: a Brief Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6883649/

  The purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis and treatment, including areas of controversy and uncertainty. […] Management strategy for central apnea aim to eliminate abnormal respiratory events, stabilize sleep and alleviate the underlying clinical condition. Positive pressure therapy (PAP) remains a standard therapy for central as well as obstructive apnea. Other treatment options include adaptive-servo ventilation (ASV), supplemental oxygen, phrenic nerve stimulation, and pharmacologic therapy. However, ASV is contraindicated in patients with central sleep apnea who had heart failure with reduced ejection fraction, owing to increased mortality in this population. […] There are several therapeutic options for central apnea. Randomized controlled studies are needed to ascertain the long-term effectiveness of individual, or combination, treatment modalities in different types of central apnea.

• #33 Diagnostic and therapeutic approach of central sleep apnea in heart failure – the role of adaptive servo-ventilation. A statement of the Portuguese society of pulmonology and the Portuguese sleep association | Pulmonology

  https://journalpulmonology.org/en-diagnostic-therapeutic-approach-central-sleep-articulo-S2531043722000058

  It is known that patients with heart failure (HF) have an increased risk of developing central sleep apnoea (CSA), with Cheyne-Stokes respiration. The development of servo-ventilation aimed to treat CSA and improve the quality of life (QoL) of these patients. […] The study also showed poor adherence, methodological and statistical gaps, including study design, patient selection, data collection and analysis, treatment adherence, and group crossovers, which have not been discussed in the trial as potential confounding factors and raise several concerns. Moreover, the adaptive servo-ventilation (ASV) device used in SERVE-HF was unable to lower the minimum support pressure below 3 mm H20, and this has been suggested as one of the probable contributing reasons to the excess mortality observed in this study. This limitation has since been solved, and this ASV device is no longer used.

• #34 Central Sleep Apnea Syndromes Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/304967-treatment

  ASV is used for treatment for CSA, especially CSB-CSA. […] Studies demonstrate that ASV is superior to conventional positive airway pressure therapy for controlling the number of central sleep apneas, improving sleep architecture and daytime hypersomnolence, particularly for CSB-CSA, central sleep apnea syndrome, and complex sleep apnea. […] Supplemental oxygen may be effective in some patients with CSB-CSA due to heart failure and has also been shown to improve ejection fraction. […] Overdrive atrial pacing has been shown to reduce both obstructive and central apneas in patients with sleep-disordered breathing who have dual-chamber pacemakers. […] In October 2017, the US Food and Drug Administration (FDA) approved an implantable device for the treatment of central sleep apnea. […] Self-report questionnaires following 12 months of usage of TPNS therapy reported significant improvements of symptoms with 45% of patients indicating cessation of daytime sleepiness, 44% cessation of fatigue/weakness, and 52% no longer having difficulty falling/staying asleep.

• #35 Central Sleep Apnea – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/central-sleep-apnea

  Treatment of underlying disorders […] Primary treatment of symptomatic central sleep apnea is often optimal management of underlying disorders (eg, heart failure) and avoidance or reduction of opioids, alcohol, and other sedatives. […] Secondary treatment of patients with symptomatic CSA can be a trial of supplemental oxygen or respiratory stimulants. Other patients may use positive airway pressure or other devices, depending on the underlying disorder. […] For patients who have CSA and Cheyne-Stokes breathing despite optimization of cardiac function, supplemental oxygen may decrease apneic and hypopneic episodes. Similarly, continuous positive airway pressure (CPAP) can sometimes be effective in treating heart failure and Cheyne-Stokes breathing by decreasing hypoxemia and reducing preload and afterload.

• #36 Central Sleep Apnea in Adults: An Interdisciplinary Approach to Diagnosis and Management—A Narrative Review

  https://www.mdpi.com/2077-0383/14/7/2369

  Adaptive servo ventilation (ASV) provides individualized ventilatory support (IPAP and EPAP) based on the detection of apneas. […] Nocturnal supplemental oxygen is beneficial in patients with heart failure by increasing EFLV, reducing hypoxemia and hyperventilation secondary to changes in PaCO2, minimizing the respiratory effort, and overall improving quality of life. […] A newer therapy for CSA is electrical stimulation of the phrenic nerve.

• #37 Central Sleep Apnea | SleepApnea.org

  https://www.sleepapnea.org/central-sleep-apnea/?srsltid=AfmBOooninVXfxPutpYjL5HEJRei3tfN8pa58uAYV7mYKaTY8F1UbXlT

  Positive airway pressure (PAP) therapy: PAP therapy includes several different types, including CPAP, ASV, and BiPAP. These are all methods of delivering pressurized air to keep the airway open during sleep. […] Supplemental oxygen: Supplemental oxygen delivers extra oxygen to help correct breathing disruptions and normalize oxygen levels in the blood. Supplemental oxygen may be used alone or at the same time as PAP therapy. […] Medication: In some cases, a doctor may recommend medications that stimulate breathing. Although medications may be helpful for people who don’t respond to other treatments, medications to stimulate breathing are also associated with significant side effects and must be closely monitored by a doctor. […] Nerve stimulation: Phrenic nerve stimulation is another treatment for people with CSA who don’t respond to other therapies. This treatment involves having a medical device implanted in the upper chest, which uses an electrical current to stimulate breathing during sleep. Phrenic nerve stimulation is typically only available in specialized facilities.

• #38 Central Sleep Apnea Treatments: PAP Machines, Oxygen Therapy, and More

  https://www.healthline.com/health/central-sleep-apnea-treatment

  Treatments for central sleep apnea may include a PAP machine, oxygen therapy, phrenic nerve stimulator, or medication. […] This article examines treatment options for central sleep apnea, including PAP machines, oxygen therapy, phrenic nerve stimulators, and medication. […] The treatment goal for central sleep apnea is to reduce complications from insufficient sleep and lower the risk of related chronic conditions by minimizing the number of sleep disturbances you experience. […] Positive airway pressure (PAP) is the standard treatment for central sleep apnea. […] PAP machines can help keep your airways open while you sleep, which stabilizes the amount of air coming in and out of your body. […] Your doctor may recommend oxygen if you register low oxygen levels during your sleep study.

• #39 Central sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

  A newer therapy for central sleep apnea is transvenous phrenic nerve stimulation. A device approved by the U.S. Food and Drug Administration known as Remede System delivers an electrical pulse to the nerve that controls the diaphragm during sleep. This causes you to take a breath. The system includes a battery-powered pulse generator that’s implanted under the skin in the upper chest. […] Used for moderate to severe central sleep apnea, this system produces a steady breathing pattern. More study is needed.

• #40 Innovative treatment for Central Sleep Apnea | remedē® System

  https://remede.zoll.com/remede-system/

  If restless nights are disrupting your days, it may be time to consider the remed113 System—the first and only FDA-approved non-mask therapy designed to treat moderate to severe central sleep apnea (CSA) in adults. […] remed113 is an implantable device that activates automatically and restores a more normal breathing pattern so that you can treat your CSA without a mask or medications. […] The remed113 System stimulates the phrenic nerve so that the brain doesn’t have to. remed113 turns on automatically and works continuously to monitor and stabilize breathing—restoring a more restful sleep. […] The remed113 System reduces the number of sleep apnea events and improves sleep quality, as well as improves daytime sleepiness and quality of life as assessed by patients. […] The remed113 System is an implantable, battery-powered device placed under the skin in the upper chest area.

• #41 Innovative treatment for Central Sleep Apnea | remedē® System

  https://remede.zoll.com/remede-system/

  If restless nights are disrupting your days, it may be time to consider the remed113 System—the first and only FDA-approved non-mask therapy designed to treat moderate to severe central sleep apnea (CSA) in adults. […] remed113 is an implantable device that activates automatically and restores a more normal breathing pattern so that you can treat your CSA without a mask or medications. […] The remed113 System stimulates the phrenic nerve so that the brain doesn’t have to. remed113 turns on automatically and works continuously to monitor and stabilize breathing—restoring a more restful sleep. […] The remed113 System reduces the number of sleep apnea events and improves sleep quality, as well as improves daytime sleepiness and quality of life as assessed by patients. […] The remed113 System is an implantable, battery-powered device placed under the skin in the upper chest area.

• #42 FDA approves implantable device to treat moderate to severe central sleep apnea | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-implantable-device-treat-moderate-severe-central-sleep-apnea

  The U.S. Food and Drug Administration today approved a new treatment option for patients who have been diagnosed with moderate to severe central sleep apnea. The Remed System is an implantable device that stimulates a nerve located in the chest that is responsible for sending signals to the diaphragm to stimulate breathing. […] This implantable device offers patients another treatment option for central sleep apnea, said Tina Kiang, Ph.D., acting director of the Division of Anesthesiology, General Hospital, Respiratory, Infection Control, and Dental Devices in the FDAs Center for Devices and Radiological Health. Patients should speak with their health care providers about the benefits and risks of this new treatment compared to other available treatments. […] The Remed System is comprised of a battery pack surgically placed under the skin in the upper chest area and small, thin wires that are inserted into the blood vessels in the chest near the nerve (phrenic) that stimulates breathing. The system monitors the patients respiratory signals during sleep and stimulates the nerve to move the diaphragm and restore normal breathing. […] The FDA granted approval of Remed System to Respicardia Inc.

• #43 Central Sleep Apnea Syndromes Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/304967-treatment

  ASV is used for treatment for CSA, especially CSB-CSA. […] Studies demonstrate that ASV is superior to conventional positive airway pressure therapy for controlling the number of central sleep apneas, improving sleep architecture and daytime hypersomnolence, particularly for CSB-CSA, central sleep apnea syndrome, and complex sleep apnea. […] Supplemental oxygen may be effective in some patients with CSB-CSA due to heart failure and has also been shown to improve ejection fraction. […] Overdrive atrial pacing has been shown to reduce both obstructive and central apneas in patients with sleep-disordered breathing who have dual-chamber pacemakers. […] In October 2017, the US Food and Drug Administration (FDA) approved an implantable device for the treatment of central sleep apnea. […] Self-report questionnaires following 12 months of usage of TPNS therapy reported significant improvements of symptoms with 45% of patients indicating cessation of daytime sleepiness, 44% cessation of fatigue/weakness, and 52% no longer having difficulty falling/staying asleep.

• #44 Innovative treatment for Central Sleep Apnea | remedē® System

  https://remede.zoll.com/remede-system/

  As with any surgically implanted device, there are risks related to the implant procedure which may include, but are not limited to, pain, swelling and infection. […] About 1 month after your procedure, therapy will be started. […] The remed113 System should not be placed if an active infection is present. […] The remed113 System has received MR conditional approval in the United States only.

• #45 Sleep Apnea – Diagnosis and Treatment for Adults – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/sleep-disorders/sleep-apnea

  Central sleep apnea is a less common form of sleep apnea. This condition is different from obstructive sleep apnea, as central sleep apnea occurs when your brain fails to send proper signals to the muscles that control your breathing. Central sleep apnea may occur as a result of other conditions, such as heart failure and arrhythmias. […] Treatment for central sleep apnea may include oxygen, continuous positive airway pressure (CPAP), or bi-level positive airway pressure (bi-level PAP). Some types of central sleep apnea are treated with drugs that stimulate breathing. The UChicago Sleep Center Cardio-Sleep program leads diaphragmatic nerve implantation, a safe and effective treatment for CSA and alternative for PAP therapy. Sleep experts can determine if this is a treatment for you. […] Diaphragmatic pacing safely and effectively treats moderate to severe central sleep apnea. The device is an implantable system that stimulates the phrenic nerve, the nerve that sends signals to the large muscle that controls breathing (diaphragm). The stimulation results in breathing in the same way the brain signals breathing. It is a minimally invasive outpatient procedure completed by a cardiologist.

• #46 Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p968.html

  Central sleep apnea syndromes are characterized by sleep-disordered breathing associated with absent or diminished respiratory effort. This practice parameter reviews available data on the treatment of central sleep apnea syndromes in adults. […] Positive airway pressure therapy may be considered for the treatment of primary central sleep apnea syndromes. (Option.) Positive airway pressure therapy includes continuous positive airway pressure (CPAP), bilevel positive airway pressure in a spontaneous-timed mode, and adaptive servo-ventilation. […] Acetazolamide has limited supporting evidence, but may be considered for the treatment of primary central sleep apnea syndromes. (Option.) […] The use of zolpidem (Ambien) and triazolam (Halcion) may be considered for the treatment of primary central sleep apnea syndromes only if the patient does not have underlying risk factors for respiratory depression. (Option.)

• #47 Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p968.html

  CPAP therapy targeted to normalize the apnea-hypopnea index is indicated for the initial treatment of central sleep apnea syndromes related to congestive heart failure (CHF). (Standard.) […] Bilevel positive airway pressure therapy in a spontaneous timed mode targeted to normalize the apnea-hypopnea index may be considered for the treatment of central sleep apnea related to CHF only if there is no response to adequate trials of CPAP, adaptive servo-ventilation, and oxygen therapies. (Option.) […] Adaptive servo-ventilation targeted to normalize the apnea-hypopnea index is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Nocturnal oxygen therapy is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Acetazolamide and theophylline have limited supporting evidence, but may be considered for the treatment of central sleep apnea syndromes related to CHF after optimization of standard medical therapy, if positive airway pressure is not tolerated and if accompanied by close clinical follow-up. (Option.) […] The following possible treatment options for central sleep apnea syndromes related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (Option.)

• #48 Central Sleep Apnea: Causes, Symptoms, and Treatments

  https://www.webmd.com/sleep-disorders/sleep-apnea/central-sleep-apnea

  Treatment might depend on the cause of your apnea and might involve taking medicine for heart failure or stopping an opioid medication. […] Continuous positive airway pressure (CPAP) can help people with all kinds of sleep apnea, especially CSA caused by heart failure. […] A device called the Remede System can help with moderate to severe central sleep apnea. Your doctor implants a small machine under the skin in your upper chest. It helps trigger the nerve that moves your diaphragm when you breathe. It also monitors your respiratory signals while you sleep and helps restore regular breathing patterns. […] Medications like acetazolamide (Diamox) and theophylline (Theochron) can stimulate breathing.

• #49 Central Sleep Apnea – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/central-sleep-apnea

  More advanced PAP ventilation strategies such as adaptive servoventilation (ASV) have also been used. […] Acetazolamide, which causes increased bicarbonate excretion and metabolic acidosis and stimulates respiration, is effective for CSA caused by high altitude and is useful in some patients with heart failure. […] Electrical pacing of the diaphragm, typically done by transvenous phrenic nerve stimulation, is an option, such as for children 2 years with congenital central hypoventilation syndrome, or for adults with symptomatic recurrent CSA.

• #50 Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p968.html

  Central sleep apnea syndromes are characterized by sleep-disordered breathing associated with absent or diminished respiratory effort. This practice parameter reviews available data on the treatment of central sleep apnea syndromes in adults. […] Positive airway pressure therapy may be considered for the treatment of primary central sleep apnea syndromes. (Option.) Positive airway pressure therapy includes continuous positive airway pressure (CPAP), bilevel positive airway pressure in a spontaneous-timed mode, and adaptive servo-ventilation. […] Acetazolamide has limited supporting evidence, but may be considered for the treatment of primary central sleep apnea syndromes. (Option.) […] The use of zolpidem (Ambien) and triazolam (Halcion) may be considered for the treatment of primary central sleep apnea syndromes only if the patient does not have underlying risk factors for respiratory depression. (Option.)

• #51 Central sleep apnea: Treatment – UpToDate

  https://www.uptodate.com/contents/central-sleep-apnea-treatment

  Central sleep apnea: Treatment […] In this topic review, we present an approach to treating CSA. […] CSA can alternatively be categorized as hyperventilation- or hypoventilation-related. Hyperventilation-related CSA encompasses most of the types of CSA mentioned above. Hypoventilation-related CSA occurs in disorders in which there is alveolar hypoventilation that is so severe that central apneas occur when the patient falls asleep because the wakefulness stimulus to breathe disappears. […] The evaluation and management of sleep-disordered breathing in this context is reviewed separately.

• #52 Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p968.html

  CPAP therapy targeted to normalize the apnea-hypopnea index is indicated for the initial treatment of central sleep apnea syndromes related to congestive heart failure (CHF). (Standard.) […] Bilevel positive airway pressure therapy in a spontaneous timed mode targeted to normalize the apnea-hypopnea index may be considered for the treatment of central sleep apnea related to CHF only if there is no response to adequate trials of CPAP, adaptive servo-ventilation, and oxygen therapies. (Option.) […] Adaptive servo-ventilation targeted to normalize the apnea-hypopnea index is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Nocturnal oxygen therapy is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Acetazolamide and theophylline have limited supporting evidence, but may be considered for the treatment of central sleep apnea syndromes related to CHF after optimization of standard medical therapy, if positive airway pressure is not tolerated and if accompanied by close clinical follow-up. (Option.) […] The following possible treatment options for central sleep apnea syndromes related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (Option.)

• #53 Basics of Central Sleep Apnea

  https://www.acc.org/Latest-in-Cardiology/Articles/2014/07/22/08/25/Basics-of-Central-Sleep-Apnea

  As opposed to obstructive sleep apnea (OSA), central sleep apnea is characterized by repetitive cessation of ventilation during sleep resulting from lack of ventilatory effort or drive to breathe. […] There are several types of treatment options for CSA, starting with treating the underlying cause. […] Treating the underlying cause of CSA (e.g. heart failure in Cheyne-Stokes respirations, reduction of respiratory depressant dosing), is generally recommended first. […] In patients with heart failure and CSA, medical management of heart failure seems to be overall helpful in treating CSA. […] Diuresis with a reduction in cardiac filling pressure has been shown to reduce the severity of CSA. […] Angiotensin-Converting Enzyme inhibition can lower the AHI and reduce the nocturnal desaturation of patients with mild to moderate heart failure.

• #54 Basics of Central Sleep Apnea

  https://www.acc.org/Latest-in-Cardiology/Articles/2014/07/22/08/25/Basics-of-Central-Sleep-Apnea

  -adrenergic blockade has been reported to decrease AHI in patients with CSA. […] Supplemental Nocturnal Oxygen alone has been shown to eliminate apnea-related hypoxia and CSA. […] There are actually several PAP solutions for patients with OSA and CSA. […] Continuous positive airway pressure therapy (CPAP) is prescribed to maintain airway patency in obstructive events. […] Adaptive servo-ventilation (ASV) is an advanced BiPAP device that has an exquisite automated algorithm that not only detects central apneas, but also adjusts the rate delivery of the backup breath depending on the respiratory needs. […] Newer forms of ventilatory support (such as ASV devices) allow better overall treatment efficacy and tolerability than traditional CPAP, especially for patients who have CSA (with or without OSA). […] Although to date none of the currently available therapies have improved long-term cardiovascular outcomes, a number of studies support treating central sleep apnea.

• #55 Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p968.html

  CPAP therapy targeted to normalize the apnea-hypopnea index is indicated for the initial treatment of central sleep apnea syndromes related to congestive heart failure (CHF). (Standard.) […] Bilevel positive airway pressure therapy in a spontaneous timed mode targeted to normalize the apnea-hypopnea index may be considered for the treatment of central sleep apnea related to CHF only if there is no response to adequate trials of CPAP, adaptive servo-ventilation, and oxygen therapies. (Option.) […] Adaptive servo-ventilation targeted to normalize the apnea-hypopnea index is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Nocturnal oxygen therapy is indicated for the treatment of central sleep apnea syndromes related to CHF. (Standard.) […] Acetazolamide and theophylline have limited supporting evidence, but may be considered for the treatment of central sleep apnea syndromes related to CHF after optimization of standard medical therapy, if positive airway pressure is not tolerated and if accompanied by close clinical follow-up. (Option.) […] The following possible treatment options for central sleep apnea syndromes related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (Option.)

• #56 Sleep Apnea In Children | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/central-sleep-apnea/

  Central sleep apnea (CSA) is a pause in breathing during sleep, usually without snoring or gasping. […] Your doctor will recommend treatments depending on the specific cause of your child’s CSA. If prematurity is the cause, supplemental oxygen is often the treatment until the child’s breathing matures. A second sleep study is often done as the child grows to reassess breathing and to make sure the child is outgrowing CSA. […] For children who have neurological problems causing the CSA, the treatment is often to assist breathing at night with oxygen. Continuous positive airway pressure (CPAP) or bi-level positive air pressure (PAP) therapy can help a child regulate their breathing, by delivering air pressure through a nasal mask while they are sleeping. […] The Children’s Colorado Sleep Team is an excellent resource for treating children and adolescent with CSA. Or providers are known internationally for their expertise in sleep research and sleep treatments.

• #57 Sleep Apnea in People with PWS

  https://www.fpwr.org/blog/sleep-apnea-in-people-with-pws

  The long-term impact of central sleep apnea on infants is not entirely clear. However, obstructive sleep apnea and intermittent lack of oxygen have been associated with poorer cognitive development. Therefore, it would not be surprising if central sleep apnea had similar negative impacts on brain development. If that is the case, it is likely that early detection of the problem and appropriate treatment would have positive effects on brain development. […] Central sleep apnea appears to be common in infants with PWS, occurs with less frequency in older children with PWS, and can be improved with supplemental oxygen during sleep. […] The current standard therapy for obstructive sleep apnea is continuous positive airway pressure (CPAP). However, many patients don’t respond to CPAP, and others don’t use it as prescribed because of discomfort. […] The results show an 84% reduction in breathing pauses and an 11% increase in blood oxygen levels, suggesting that hypoglossal nerve stimulation (HGNS) may be an alternative for those who can’t tolerate CPAP.

• #58 Treating and Managing Sleep Apnea | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/sleep-apnea/treating-and-managing

  There are several ways to treat sleep apnea. No matter what treatment you choose, your healthcare provider may want you to do a follow-up sleep study to make sure your sleep apnea is well managed. […] Many of the above treatment options may also be considered for central sleep apnea. Other treatments your healthcare provider may discuss with you include adjusting current medications that may affect your nighttime breathing, adding medication to stimulate breathing or surgical considerations such as a nerve stimulator.

• #59 Central Sleep Apnoea (CSA) treatment options | ResMed

  https://me.resmed.com/professionals/sleep-apnoea/treatment-options-for-csa/

  It can be challenging to treat patients with CSA, who often experience fewer or different symptoms than OSA patients. Adaptive servo-ventilation, as delivered by the AirCurve 10 CS PaceWave, is an appropriate choice for treating most of these more complex patients. […] Continuous positive airway pressure or automatic positive airway pressure (CPAP/APAP) therapy is often used as the treatment of first intention, but experience shows that CPAP/APAP does not consistently control apnoeas or improve symptoms. As a result, some patients treated with CPAP/APAP remain symptomatic. This increases the risk of non-compliance and the likelihood that they will require multiple, resource-intensive interventions. […] Adaptive servo-ventilation is often an appropriate choice for treating these more complex patients, either as a first intention therapy or after an unsuccessful trial with other positive airway pressure (PAP) therapies.

• #60 Central Sleep Apnea (CSA) | Treatment for Central Sleep Apnea

  https://www.valleyhealth.com/services/central-sleep-apnea

  Central sleep apnea (CSA) is a serious condition in which a persons sleep is interrupted because the brain doesnt send the proper signals to the diaphragm during sleep. This can cause lapses in breathing. […] Traditionally, central sleep apnea has been difficult to treat, frequently resistant to medical therapy and unresponsive to CPAP, the usual therapy for obstructive sleep apnea. […] At Valley, moderate to severe central sleep apnea is treated using the remed System. This innovative, FDA-approved device has been proven to reduce the number of sleep apnea events, as well as improve patients quality of life and overall cardiovascular health. […] Our multidisciplinary team consisting of a sleep medicine specialist, electrophysiologists and a heart failure specialist works together to determine appropriate patients for treatment using the remed System; implant the device; and monitor patients improvement.

• #61 ECU Health offers innovative treatment option for patients with Central Sleep Apnea – ECU Health

  https://www.ecuhealth.org/ecu-health-offers-innovative-treatment-option-for-patients-with-central-sleep-apnea/

  The remed System is an innovative, FDA-approved medical implant indicated for adult patients with Central Sleep Apnea (CSA) and its now an available treatment option for certain ECU Health patients. […] The remed System provides a significant advance in the treatment of CSA when other interventions are not effective. […] Dr. John Catanzaro, the division chief of cardiology at East Carolina Heart Institute, sees the remed System as an important option for patients with CSA. Theres a very low risk with this treatment, and phrenic nerve stimulation is a contemporary option for patients with CSA who havent responded well to other therapies, he said. […] Once the implantation site is healed, the Sleep Center team takes over to determine how to administer the therapy and restore the patients sleep pattern.

• #62 Central Sleep Apnea (CSA) | Treatment for Central Sleep Apnea

  https://www.valleyhealth.com/services/central-sleep-apnea

  Central sleep apnea (CSA) is a serious condition in which a persons sleep is interrupted because the brain doesnt send the proper signals to the diaphragm during sleep. This can cause lapses in breathing. […] Traditionally, central sleep apnea has been difficult to treat, frequently resistant to medical therapy and unresponsive to CPAP, the usual therapy for obstructive sleep apnea. […] At Valley, moderate to severe central sleep apnea is treated using the remed System. This innovative, FDA-approved device has been proven to reduce the number of sleep apnea events, as well as improve patients quality of life and overall cardiovascular health. […] Our multidisciplinary team consisting of a sleep medicine specialist, electrophysiologists and a heart failure specialist works together to determine appropriate patients for treatment using the remed System; implant the device; and monitor patients improvement.

• #63 Central Sleep Apnea: a Brief Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6883649/

  The purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis and treatment, including areas of controversy and uncertainty. […] Management strategy for central apnea aim to eliminate abnormal respiratory events, stabilize sleep and alleviate the underlying clinical condition. Positive pressure therapy (PAP) remains a standard therapy for central as well as obstructive apnea. Other treatment options include adaptive-servo ventilation (ASV), supplemental oxygen, phrenic nerve stimulation, and pharmacologic therapy. However, ASV is contraindicated in patients with central sleep apnea who had heart failure with reduced ejection fraction, owing to increased mortality in this population. […] There are several therapeutic options for central apnea. Randomized controlled studies are needed to ascertain the long-term effectiveness of individual, or combination, treatment modalities in different types of central apnea.

• #64

  https://link.springer.com/article/10.1007/s40675-024-00311-x

  Central sleep apnea (CSA) is associated with increased mortality, particularly in heart failure. This review discusses current treatment options with a focus on different positive airway pressure (PAP) modalities, the clinical implication of continuous PAP (CPAP) failure, and key advancements in adaptive servo-ventilation (ASV). […] CPAP reduces CSA by about 50% in patients with heart failure with reduced ejection fraction. The remaining patients are considered non-responsive and chronic use of CPAP has been associated with excess mortality. ASV is effective in several forms of CSA. […] Physicians should consider the underlying pathophysiology, overall prognosis, and evidence base prior to selecting CSA treatment with CPAP or ASV. Promising pharmaceutical and novel device options require more studies and long-term evidence.

• #65 Central Sleep Apnea: a Brief Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6883649/

  The purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis and treatment, including areas of controversy and uncertainty. […] Management strategy for central apnea aim to eliminate abnormal respiratory events, stabilize sleep and alleviate the underlying clinical condition. Positive pressure therapy (PAP) remains a standard therapy for central as well as obstructive apnea. Other treatment options include adaptive-servo ventilation (ASV), supplemental oxygen, phrenic nerve stimulation, and pharmacologic therapy. However, ASV is contraindicated in patients with central sleep apnea who had heart failure with reduced ejection fraction, owing to increased mortality in this population. […] There are several therapeutic options for central apnea. Randomized controlled studies are needed to ascertain the long-term effectiveness of individual, or combination, treatment modalities in different types of central apnea.

• #66

  https://link.springer.com/article/10.1007/s40675-024-00311-x

  Central sleep apnea (CSA) is associated with increased mortality, particularly in heart failure. This review discusses current treatment options with a focus on different positive airway pressure (PAP) modalities, the clinical implication of continuous PAP (CPAP) failure, and key advancements in adaptive servo-ventilation (ASV). […] CPAP reduces CSA by about 50% in patients with heart failure with reduced ejection fraction. The remaining patients are considered non-responsive and chronic use of CPAP has been associated with excess mortality. ASV is effective in several forms of CSA. […] Physicians should consider the underlying pathophysiology, overall prognosis, and evidence base prior to selecting CSA treatment with CPAP or ASV. Promising pharmaceutical and novel device options require more studies and long-term evidence.

• #67 Reddit – The heart of the internet

  https://www.reddit.com/r/SleepApnea/comments/14cqt6k/its_not_all_in_my_head_its_actually_severe/

  When I finally got a sleep test done, it quickly relieved severe central sleep apnea. […] Tomorrow is my appointment with my respirologist who will prescribe me my treatment and I’m beyond excited. […] I’m finally happy to just have answers. And I’m really excited to get treatment!

• #68 Sleep Apnea: Symptoms, Risks and Treatments | SleepApnea.org

  https://www.sleepapnea.org/?srsltid=AfmBOooZm9o4H-D0_8CNxoH3GpU0JPShreaOPDh_8k5Fou6NUU2pQJev

  Central sleep apnea is a sleep disorder that affects breathing during sleep. Learn more about the causes, symptoms, and treatments… […] If you have sleep apnea, you have a medical condition that prevents you from breathing normally. If you’re not getting healthy sleep, your brain and body cannot rejuvenate. Ultimately, untreated sleep apnea is a gateway medical condition because it erodes vital systems you depend on, burns through your reserves, and ages your body quicker. Sleeping poorly has the power to ruin the last 10 years of your life, not to mention how you function on a day-to-day level, but getting the right treatment can turn everything around.

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