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What Is Treatment Emergent Central Sleep Apnea

What Are The Different Types Of Central Sleep Apnea

Other Key Areas of Interest for ASV, Complex Sleep Apnea and Treatment Emergent CSA…

Central sleep apnea is divided into two categories, and each of the categories has its subtypes.

The first category we will walk you through is the hypoventilation type. In this type of central sleep apnea, the brain fails to effectively send signals to the respiratory muscle to initiate breathing. Often, carbon dioxide builds up in these cases. Hypoventilation-type of central sleep apnea includes the following subtypes:

  • Narcotic-Induced Central Sleep Apnea: In this type of central sleep apnea, the use of narcotics, such as opioids, diminishes the brains ability to properly initiate and regulate breathing.
  • Central Sleep Apnea Related to a Medical Condition: This type of central sleep apnea often occurs as a result of a stroke, tumor, or trauma affecting the brain. Typically, the brain stem, a part of the brain that helps control breathing, is affected.

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  • Congenital Central Hypoventilation Syndrome : CCHS is a very rare genetic condition that most often affects newborns or very young children. There is a lack of signal to breathe during wakefulness and sleep
  • Central Sleep Apnea Due to Neuromuscular Disease: Typically seen in amyotrophic lateral sclerosis or multiple sclerosis, central sleep apnea emerges due to extreme weakness in the respiratory muscles.

What Causes Central Sleep Apnea In Children

Central sleep apnea can occur for a variety of reasons in children. It is important to note that a few central apnea events during sleep is considered normal. Central sleep apnea has been associated with rare genetic disorders in children, such as congenital central hypoventilation syndrome. It may also be present when children have health conditions that interfere with parts of the central nervous system that controls breathing.

Sleep Apnea Cardiovascular Risk And Metabolism

Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan, says Jun. Why this connection? For one thing, obesity is common in sleep apnea patients, and obesity greatly increases risks of diabetes, stroke and heart attack, he says. In most cases, obesity is the main culprit behind both conditions, Jun explains.

Still, its important to note that not everyone with sleep apnea is obese. Furthermore, evidence suggests an independent link between sleep apnea and diabetes. Our lab and others have shown that sleep apnea is associated with higher risks of diabetes, independent of obesity, and that sleep apnea can increase blood sugar levels, says Jun.

For people who are overweight or obese, weight loss is key for treating or avoiding sleep apnea. People who accumulate fat in the neck, tongue and upper belly are especially vulnerable to getting sleep apnea. This weight reduces the diameter of the throat and pushes against the lungs, contributing to airway collapse during sleep.

Women in particular should be careful as they age. While premenopausal women tend to put on weight in the hips and in the lower body instead of the belly, this shifts with time. Weight begins to accumulate in traditionally male areas like the tummy, and this leads to a greater chance of sleep apnea.

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What Causes Complex Sleep Apnea

Central sleep apnea may emerge during titration of CPAP in patients previously diagnosed with obstructive sleep apnea. This syndrome, termed complex sleep apnea, has become a controversial topic in the sleep literature and has been raised as a possible type of difficult-to-treat obstructive sleep apnea. As many as 6.5% of patients with obstructive sleep apnea may develop emergent or persistent central sleep apnea with CPAP treatment. CPAP emergent central sleep apnea is generally transitory and is eliminated after eight weeks of CPAP therapy. Persistent CPAP-related central sleep apnea has been observed in approximately 1.5% of treated patients. Similarly, complex sleep apnea can occur following a tracheostomy for obstructive sleep apnea. Central apneas have been found initially after a tracheostomy, but after an extended period, central sleep apnea decreased on repeat PSG.

What Are The Types Of Sleep Apnea

A Case Of Treatment Emergent Central Sleep Apnea

There are three types of sleep apnea:

  • Obstructive Sleep Apnea : OSA occurs when the airway at the back of the throat becomes physically blocked. That obstruction causes temporary lapses in breath.
  • Central Sleep Apnea : CSA happens because there is a problem with the brains system for controlling muscles involved in respiration, leading to slower and shallower breathing.
  • Mixed Sleep Apnea: When a person has both OSA and CSA at the same time, it is referred to as mixed sleep apnea or complex sleep apnea.

Because the underlying causes are distinct, there are important differences in the symptoms, causes, and treatments of OSA and CSA.

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Central Sleep Apnea Treatment: Adaptive Servo Ventilation

If you suffer from sleep apnea, there are a variety of methods you can try to reduce your symptoms and live a happier and healthier life. One central sleep apnea treatment you and your doctor may want to consider is adaptive servo ventilation. This new sleep apnea device is showing positive results for patients with central sleep apnea and other sleeping disorders. Gain a better understanding of adaptive servo ventilation and how it works, so that you can decide whether its the right sleep apnea treatment for you.

How Is Central Sleep Apnea Different From Obstructive Sleep Apnea

In obstructive sleep apnea, a person makes a notable effort to breathe, but the airway in the back of the throat is blocked. The blockage in the back of the throat causes an obstruction to our windpipe, which leads to sleep fragmentation and a disturbed oxygen balance in the body.

In central sleep apnea, the problem isnt a blocked airway. Instead, pauses in breathing occur because the brain and the muscles that control breathing arent functioning properly. As a result, there is no normal respiratory effort, which is in clear contrast to OSA.

While OSA and CSA are separate conditions, they can arise at the same time in what is known as mixed sleep apnea. In addition, treatment of OSA with continuous positive airway pressure , can induce central sleep apnea, and this is called treatment-emergent central sleep apnea.

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Can Central Sleep Apnea Be Cured

While certain risk factors for central sleep apnea, such as age and gender, cannot be helped, there are some that you may have more control over, including opioid and CPAP use. However, it is vital to consult with your doctor to find a safe and appropriate alternative to reduce your chances of CSA.

Completely getting rid of central sleep apnea is likely dependent on the underlying issue that is causing it. While some central sleep apnea cases may not entirely go away, treatments should help you attain a safer, more peaceful nights rest.

Oral Appliances / Functional Orthopedic Appliances

The remed® System for Central Sleep Apnea

Evidence to support oral appliances/functional orthopedic appliances in children is insufficient with very low evidence of effect. However, the oral appliances/functional orthopedic appliances may be considered in specified cases as an auxiliary in the treatment of children who have craniofacial anomalies which are risk factors of apnea.

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Diagnosing And Treating Sleep Apnea For Better Health

Its important to treat sleep apnea, because it can have long-term consequences for your health. While there have been some high-profile deaths linked to sleep apneasuch as with Judge Antonin Scalia Jun says that the true risk is from damage done over time.

Obstructive sleep apnea can range from mild to severe, based on a measurement system called the apnea-hypopnea index . The AHI measures the number of breathing pauses that you experience per hour that you sleep.

Obstructive sleep apnea is classified by severity:

  • Severe obstructive sleep apnea means that your AHI is greater than 30
  • Moderate obstructive sleep apnea means that your AHI is between 15 and 30
  • Mild obstructive sleep apnea means that your AHI is between 5 and 15

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Whether or not you need treatment for sleep apnea depends on its severity, whether or not you have symptoms such as sleepiness and other health conditions. For example, if you have risk factors for heart disease, your doctor might opt to treat you even for mild sleep apnea. On the other hand, if you have a severe case of sleep apnea, your doctor might insist on treatment even if youre not sleepy.

Not very relaxing, right? Luckily, its treatable.

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What Is Adaptive Servo Ventilation

Created in 1998, Adaptive Servo Ventilation is a non-invasive method for treating central sleep apnea and other conditions such as complex sleep apnea, mixed sleep apnea, and Cheyne-Stokes. Adaptive servo ventilation is a relatively newcentral sleep apnea treatment that continuously monitors the breathing status of patients. Considered to be a form of positive airway pressure therapy , adaptive servo ventilation adjusts pressure delivery based on the detection of pauses, or apneas, in breathing during sleep.

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How Common Is Central Sleep Apnea

While the exact number of people with central sleep apnea is unknown, it is estimated that about .9% of people over 40 in the United States have the condition. Though it affects both men and women, it occurs more often in men of greater than 65 years old. People who have a heart condition, use narcotics, suffer from a stroke, live in high altitudes, or use CPAP are at greater risk for central sleep apnea.

Activation Of Lung Stretch Receptors

(PDF) Adapting Our Approach to Treatment

Expansion of lung volumes induced by over-titration of CPAP may lead to activation of stretch receptors in the lungs the receptors then send signals via the vagal nerve fibers to the respiratory center, which then inhibits the central respiratory output. Consequently, an interruption of inspiration will occur. This mechanism can also protect the lungs against overexpansion.

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Whats The Difference Between Central And Obstructive Sleep Apnea

The difference between obstructive and central sleep apnea is what causes periodic gaps in breathing during sleep. In contrast to central sleep apnea, obstructive apnea results from a blockage in the upper airway. More specifically, the muscles at the back of the throat relax to the point that they significantly narrow the airway, impacting the individuals breathing.

Obstructive sleep apnea doesnt appear to be going away anytime soon either. The American Academy of Sleep Medicine reports that sleep apnea numbers are rising, affecting as many as 25 million American adults.

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What Are The Health Risks Of Sleep Apnea

Sleep apnea can lead to sleep deprivation from constant nightly interruptions and shallower overall sleep. Lack of sleep is associated with far-reaching health consequences that affect a person physically, mentally, and emotionally, and as a result, it comes as no surprise that sleep apnea has been tied to diverse health problems.

Because of how it affects oxygen balance in the body, untreated sleep apnea raises dangers for various types of cardiovascular issues including high blood pressure, heart attack, heart disease, and stroke.

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Risk Factors And Clinical Characteristics

Certain risk factors, including demographic data, clinical information, and polysomnographic characteristics, are associated with a higher prevalence of TECSA .2]. Some studies identified several clinical risk factors for TECSA in OSA patients. As these studies reported, older age, male, lower body mass index, comorbid conditions , medications , certain polysomnographic parameters at the time of diagnostic polysomnography study , and titration factors in their titration studies) were associated with a higher prevalence of TECSA in OSA patients than those in matched control subjects. Lei F et al reported that higher baseline mixed sleep apnea, especially in non-rapid eye movement sleep, was related to a higher incidence of TECSA in OSA patients. Herkenrath S et al compared mixed apnea metrics during diagnostic PSG in OSA patients with or without TECSA, and found that those with TECSA had longer apneic duration, more frequent arousals, and shorter ventilatory duration, consistent with higher ventilatory control instability. However, there is still no consensus on the risk factors for TECSA, and the same risk factors are not always identified in the different studies.

Central Sleep Apnea Causes And Associations

Managing Central Sleep Apnea With Advancements In Treatment of Obstructive Sleep Apnea

Central sleep apnea is caused by a failure of a persons brain to consistently send signals to activate the breathing muscles while asleep. Central sleep apnea has a number of known associations, including2

  • Cardiac disorders, including congestive heart failure and atrial fibrillation
  • High altitude
  • Treatment emergent central sleep apnea
  • Idiopathic central sleep apnea
  • Other medical conditions

Studies have shown that up to 40% of people with congestive heart failure and 30% of people with atrial fibrillation may have central sleep apnea.10,11 In fact, heart failure is the most common cause of CSA in the general population.2


Periodic breathing appears when people are exposed to high altitudes. This may be due to how your body responds to changes in the atmosphere.2


Certain medications, including opioids, can disrupt the breathing pattern and lead to central sleep apnea.2


Treatment emergent central sleep apnea refers to central events that occur when a person is using Positive Airway Pressure therapy such as CPAP or BiPAP. Reasons for treatment emergent CSA may occur due to an increased number of arousals during titration, mask leak, or overtitration. This may improve with ongoing PAP use.2


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What Are The Risk Factors

Certain factors can put some at a greater risk of developing central sleep apnea, as reported by the Mayo Clinic.

  • Sex

Men are more likely than women to have central sleep apnea.

  • Age

Adults over the age of 60 are at an increased risk. Experts say this is likely because of additional sleep or medical issues that could induce apnea.

  • Heart disorders

Those who have atrial fibrillation or congestive heart failure also have a higher risk of this sleep disorder. Atrial fibrillation is when someone has an irregular heartbeat, while congestive heart failure is when the heart does not pump enough blood.

  • Brain conditions

Brain issues such as a stroke, tumor, or structural brainstem lesion could impair breathing.

  • Sleeping at a high altitude

If you are not used to resting at higher altitudes, that could induce central sleep apnea.

  • Opioid use

We also mentioned earlier that people who take opioid medications could develop sleep apnea.

  • CPAP use

Those using continuous positive airway pressure to treat obstructive sleep apnea are at increased risk of contracting central sleep apnea.

Central Sleep Apnea Causes And Types

There are several types of central sleep apnea, each with a different cause.

  • Cheyne-Stokes breathing. This is when your breathing speeds up, slows down, stops, and then starts again. Each of these cycles can last 30 seconds to 2 minutes. Cheyne-Stokes breathing is common in people whove had heart failure or a stroke. It happens in about half of central sleep apnea cases.
  • Narcotic-induced central sleep apnea.Opioid medications like morphine, oxycodone, and codeine can affect your breathing patterns.
  • High-altitude periodic breathing. Many people have trouble breathing when they go up to a high elevation, usually 2,500 meters or more.
  • Treatment-emergent apnea. About 5% to 15% of people who have positive airway pressure treatment for obstructive sleep apnea get CSA.
  • Medical condition-induced apnea. Health problems like heart failure, Parkinsons disease, stroke, and kidney failure can cause CSA.
  • Idiopathic central sleep apnea. This is when theres no clear cause.

A related condition named congenital central hypoventilation syndrome is linked to a certain gene. It affects about one in 200,000 children around the world.


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How Sleep Apnea Can Have An Effect On Your Well Being

If left untreated, sleep apnea is probably very harmful. Sleep apnea brings with it an elevated threat of stroke, coronary heart assault, and dementia. Sleep apnea may even be deadly in some circumstances. Working example: Sleep apnea was reported as a contributing reason behind dying for actress Carrie Fisher. Even when sleep apnea does not kill you, it undoubtedly will increase your threat of dying youthful than youd in any other case. A 2015 examine discovered that individuals with untreated sleep apnea are 86 % extra prone to die at a youthful age than individuals who havent got sleep apnea.

Untreated sleep apnea additionally leaves you open to quite a lot of different unwanted side effects and issues. Researchers have discovered a powerful hyperlink between obstructive sleep apnea and despair, for instance, though the connection between the 2 is not totally understood right now. One other examine discovered that sleep apnea may be related to erectile dysfunction in males.

Sleep apnea can also be related to liver harm and metabolic syndrome and will increase the dangers related to surgical procedure and present process anesthesia.

Sleep Apnea Remedy Choices

(PDF) Treatment

So, if you happen to do have sleep apnea, here is the excellent news: There are a number of methods to deal with sleep apnea, from residence treatments and options to surgical procedure.

Step one in assuaging obstructive sleep apnea is to make life-style adjustments. Since extra weight is a recognized reason behind this type of sleep apnea, your physician will possible suggest weight reduction and train if you happen tore obese or overweight. You can too keep away from alcohol and drugs that calm down the throat muscle mass and alter your sleeping place . When you smoke, your physician will even encourage you to cease instantly.

Your physician may additionally suggest that you just use a particular gadget known as a CPAP machine to assist deal with your sleep apnea. CPAP stands for steady optimistic airway stress, and it is administered by a machine that helps do the work of maintaining your airways open whilst you sleep. This can contain sporting a masks that pumps air by your airways. CPAP machines are efficient at treating average to extreme sleep apnea , however it may be uncomfortable for some individuals to sleep in.

Lastly, if different therapies arent working, your physician may suggest surgical procedure. In keeping with the Mayo Clinic, surgical options for sleep apnea embrace:

Tissue removing. Particularly, the surgeon would take away tissue from the again of your mouth and high of your throat. Often, this would come with a tonsillectomy.

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