pulmonary disorders
Central Sleep Apnea
Treatment of Central Sleep Apnea
Treatment of cause Supportive care Primary treatment of central sleep apnea is optimal management of underlying disorders and avoidance or reduction of opioids, alcohol, and other sedatives ( Treatment references ). Secondary treatment of symptomatic patients can be a trial of supplemental oxygen or, in patients with hypercapnic CSA who have symptoms despite other treatments, For patients who have CSA and Cheyne-Stokes breathing, supplemental oxygen may decrease apneic and hypopneic episodes; positive airway modalities have been used, but efficacy is not clear. Acetazolamide, which causes 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. Programmable phrenic nerve or diaphragm stimulation systems can produce a rhythmic breathing pattern that stabilizes tidal volume, airflow, and oxygenation, entrains breathing during sleep, and potentially alters disease progression ( Treatment references ). 1.Dempsey JA: Central sleep apnea: misunderstood and mistreated! F1000Res. 8:F1000 Faculty Rev-981, 2019. doi: 10.12688/f1000research.18358.1 2.Schwartz AR, Sgambati FP, James KJ, et al: Novel phrenic nerve stimulator treats Cheyne-Stokes respiration: polysomnographic insights.J Clin Sleep Med16(5):817–820, 2020. doi: 10.5664/jcsm.8328 