Central sleep apnea (CSA) differs from obstructive sleep apnea — the brain fails to signal breathing rather than the airway being blocked. Central sleep apnea is less common than OSA and often associated with underlying medical conditions. Treatment differs from OSA.
How CSA differs from OSA
OSA: airway closes during sleep despite breathing effort.
CSA: brain doesn’t send signal to breathe — no breathing effort during apnea events.
Both produce oxygen drops and sleep disruption but have different causes.
Causes
- Heart failure: Most common cause. Cheyne-Stokes breathing pattern
- Stroke and brainstem disease
- High altitude
- Opioid use
- CPAP-emergent (complex sleep apnea)
- Idiopathic
- Medications (some antiepileptics)
Symptoms
Similar to OSA:
- Daytime sleepiness
- Morning headaches
- Awakening short of breath
- Less likely to be reported snoring (no obstruction)
- Witnessed pauses in breathing
Diagnosis
Sleep study (polysomnogram) shows:
- Apneas without respiratory effort
- Often crescendo-decrescendo pattern (Cheyne-Stokes) in heart failure
- Distinguishes from OSA which shows continued effort
Treatment
ASV (Adaptive Servo-Ventilation): Most common treatment. Adjusts pressure dynamically to stabilize breathing.
Treating underlying cause:
- Heart failure optimization
- Reducing opioids when possible
- Treating brainstem disease if applicable
Oxygen: Sometimes used.
Phrenic nerve stimulator (Remede): Implanted device for specific CSA cases.
SERVE-HF caution
Important: SERVE-HF trial showed ASV may increase mortality in patients with reduced-ejection-fraction heart failure (EF under 45%) and predominant central sleep apnea. ASV not recommended for this specific population.
Frequently Asked Questions
Is central sleep apnea more serious than OSA?
Different concerns. Often signals underlying conditions like heart failure.
Can I use CPAP for central sleep apnea?
Generally not effective. ASV typically used.
What’s Cheyne-Stokes breathing?
Crescendo-decrescendo breathing pattern often seen in heart failure-related CSA.
Does opioid use cause sleep apnea?
Yes, can cause central apnea. Sleep evaluation may be appropriate for chronic opioid users.
Why is SERVE-HF a concern?
Specific population (reduced EF heart failure with predominant CSA) had worse outcomes on ASV.
The bottom line on central sleep apnea
Less common than OSA, often associated with underlying conditions. ASV typical treatment with specific exceptions. Discuss with sleep specialist and treating physicians.