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Central Sleep Apnea

Disease Details

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Description: Central sleep apnea is a sleep disorder in which breathing repeatedly stops and starts during sleep due to a lack of respiratory effort resulting from a failure of the brain to send proper signals to the muscles that control breathing.
Type: Central sleep apnea (CSA) is typically categorized as a sleep-related breathing disorder. Regarding genetic transmission, most cases of central sleep apnea are not directly linked to a single genetic cause or inherited in a simple Mendelian pattern. It is often associated with other medical conditions such as heart failure, stroke, or brainstem issues, rather than being primarily hereditary. However, there may be some genetic predisposition in the broader context of susceptibility to the conditions that contribute to CSA.
Signs And Symptoms: In a healthy person during sleep, breathing is regular so oxygen levels and carbon dioxide levels in the bloodstream stay fairly constant: After exhalation, the blood level of oxygen decreases and that of carbon dioxide increases. Exchange of gases with a lungful of fresh air is necessary to replenish oxygen and rid the bloodstream of built-up carbon dioxide. Oxygen and carbon dioxide receptors in the body (called chemoreceptors) send nerve impulses to the brain, which then signals for reflexive opening of the larynx (enlarging the opening between the vocal cords) and movements of the rib cage muscles and diaphragm. These muscles expand the thorax (chest cavity) so that a partial vacuum is made within the lungs and air rushes in to fill it. In the absence of central apnea, any sudden drop in oxygen or excess of carbon dioxide, even if small, strongly stimulates the brain's respiratory centers to breathe; the respiratory drive is so strong that even conscious efforts to hold one's breath do not overcome it.In pure central sleep apnea, the brain's respiratory control centers, located in the region of the human brain known as the pre-Botzinger complex, are imbalanced during sleep and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. The neurological feedback mechanism that monitors blood levels of carbon dioxide and in turn stimulates respiration fails to react quickly enough to maintain an even respiratory rate, allowing the entire respiratory system to cycle between apnea and hyperpnea, even for a brief time following an awakening during a breathing pause. The sleeper stops breathing for up to two minutes and then starts again. There is no effort made to breathe during the pause in breathing: there are no chest movements and no muscular struggling, although when awakening occurs in the middle of a pause, the inability to immediately operate the breathing muscles often results in cognitive struggle accompanied by a feeling of panic exacerbated by the feeling associated with excessive blood CO2 levels. Even in severe cases of central sleep apnea, however, the effects almost always result in pauses that make breathing irregular rather than cause the total cessation of breathing over the medium term. After the episode of apnea, breathing may be faster and/or more intense (hyperpnea) for a period of time, a compensatory mechanism to blow off retained waste gases, absorb more oxygen, and, when voluntary, enable a return to normal instinctive breathing patterns by restoring oxygen to the breathing muscles themselves.
Prognosis: The prognosis of central sleep apnea can vary depending on the underlying cause and the effectiveness of treatment. Patients with central sleep apnea due to heart failure or other serious conditions may have a more guarded prognosis. Treatment options such as the use of adaptive servo-ventilation (ASV), continuous positive airway pressure (CPAP), or addressing the underlying medical issues can significantly improve outcomes for many patients. Additionally, lifestyle changes and medical management can also improve the overall prognosis.
Onset: The onset of central sleep apnea can occur at any age. It is commonly associated with underlying medical conditions such as heart failure, stroke, or the use of opioid medications. The onset may be gradual or sudden, depending on the underlying cause.
Prevalence: The prevalence of central sleep apnea (CSA) varies, but it is generally less common than obstructive sleep apnea. CSA is estimated to affect about 0.9% of the general population. It is more frequently observed in individuals with certain conditions such as heart failure, where prevalence rates can be significantly higher, ranging from 30% to 50%.
Epidemiology: Central sleep apnea is less prevalent than obstructive sleep apnea. In one study, CSA is stated to have a prevalence of 0.9% in comparison to OSA.There are many factors that increase the risk of developing CSA. Chronic opioid use produces a mean prevalence in central sleep apnea development of 24%. An estimate of 10% of chronic kidney disease (CKD) patients have a CSA diagnosis. Cohort studies of stroke patients show a 70% development rate of CSA within 72 hours of the stroke event, although CSA was detected in less than 17% after 3 months of follow-up. Another cohort study from the Sleep Heart Healthy study showed incidence of CSA in heart failure patients to be 0.9%.
Intractability: Central sleep apnea (CSA) is not generally considered intractable. It can often be managed or treated with various interventions, including continuous positive airway pressure (CPAP) therapy, adaptive servo-ventilation (ASV), supplemental oxygen, medications, or addressing underlying conditions. Effectiveness of treatment may vary depending on the underlying cause and patient-specific factors.
Disease Severity: Central sleep apnea (CSA) is generally considered a serious condition. The severity can vary based on the frequency of apnea episodes and the presence of coexisting medical conditions, such as heart failure or neurological disorders. It requires medical evaluation and intervention to manage associated risks and underlying causes.
Healthcare Professionals: Disease Ontology ID - DOID:9220
Pathophysiology: Central sleep apnea (CSA) is characterized by impaired respiratory effort due to the instability or dysfunction of the respiratory control centers in the brain. The primary pathophysiological mechanisms involve the failure of the brain to send proper signals to the muscles that control breathing, which leads to repeated interruptions in breathing during sleep. This can be associated with conditions such as heart failure, stroke, or high altitude, and may also be idiopathic. In CSA, unlike obstructive sleep apnea, there is no physical blockage of the airway. The disrupted breathing patterns often lead to fragmented sleep and decreased blood oxygen levels.
Carrier Status: Central sleep apnea is a condition characterized by the brain's failure to send appropriate signals to the muscles that control breathing during sleep. Carrier status is not applicable to central sleep apnea as it is not typically considered a genetic disorder in the way that many inherited diseases are. Instead, it often results from other underlying health issues such as heart failure, stroke, or conditions affecting the brainstem.
Mechanism: Central sleep apnea (CSA) is characterized by a temporary cessation of breathing during sleep due to lack of respiratory effort. Here’s a concise overview of the mechanisms and molecular mechanisms:

**Mechanism:**
1. **Neurological Control:** CSA is primarily related to dysfunctions in the brainstem, which is responsible for autonomic control of breathing. These dysfunctions can lead to inadequate signaling from the brain to the respiratory muscles.
2. **Compensatory Hyperventilation:** Conditions like heart failure might cause hyperventilation, leading to reduced CO2 levels in the blood (hypocapnia). Low CO2 can blunt the drive to breathe, resulting in apnea until CO2 levels rise again, reinitiating the cycle of breathing.

**Molecular Mechanisms:**
1. **Chemoreceptor Dysfunction:** Chemoreceptors in the brainstem and peripheral nervous system monitor blood levels of CO2 and O2. Malfunction of these receptors can lead to improper respiratory responses.
2. **Neurotransmitter Imbalance:** Central neurotransmitters like serotonin and gamma-aminobutyric acid (GABA) play crucial roles in the regulation of respiratory rhythms. Imbalances or dysregulation in these neurotransmitters can contribute to CSA.
3. **Cardio-Respiratory Coupling:** Heart failure and other cardiovascular diseases can disrupt the feedback loop between cardiac and respiratory systems, influencing central respiratory control and contributing to apnea events.
4. **Genetic Factors:** Mutations or variations in genes involved in respiratory control, such as those affecting neuronal signaling pathways, can predispose individuals to CSA.

Understanding these mechanisms helps in diagnosing and tailoring appropriate treatments for patients suffering from central sleep apnea.
Treatment: After a patient receives a diagnosis, the diagnosing physician can provide different options for treatment. If central sleep apnea is medication-induced (e.g., opioids), reducing the dose or eventual withdrawal of the offending medication often improves CSA.
The FDA has recently approved a pacemaker-like implantable device called the remedē System for adult patients with moderate to severe central sleep apnea. After a commonly performed procedure, the device stimulates a nerve in the chest (phrenic nerve) to send signals to the large muscle that controls breathing (the diaphragm). It monitors respiratory signals during sleep and helps restore normal breathing patterns. The device is silent, activates automatically during the night, and does not require the patient to wear a mask.
Mechanical regulation of airflow and/or airway pressure:Treatment for central sleep apnea differs in that the device is set not at one constant optimal pressure but rather at two different settings, one for inhalation (IPAP) and for exhalation (EPAP), maintaining normal breathing rhythm by inflating the patient's lungs at regular intervals whose specifics, such as the breathing rate and the duration of a single breath, can be programmed. Devices tailored to this purpose are known as BiPAP ("bilevel positive airway pressure") devices.
Both CPAP and BiPAP devices can be connected to a humidifier to humidify and heat the inhaled air, thus reducing unpleasant symptoms such as a sore throat or blocked nose that can result from inhaling cold, dry air.
CPAP and BiPAP devices can trigger central apneas in those with obstructive sleep apnea requiring the use of an ASV (adaptive servo ventilation) device, which is also the proper machine for those who have central sleep apnea or mixed/complex apnea.
Compassionate Use Treatment: Central sleep apnea (CSA) is a condition in which the brain fails to send proper signals to the muscles that control breathing. Regarding compassionate use, off-label, or experimental treatments for CSA:

1. **Compassionate Use Treatment**: This often involves access to experimental therapies outside of clinical trials, typically for patients with severe cases who have not responded to existing treatments. Physicians may need to work with regulatory bodies and the manufacturers of the experimental treatment to gain access.

2. **Off-Label Treatments**:
- **Acetazolamide**: Primarily a diuretic, it is sometimes used off-label to stimulate breathing.
- **Theophylline**: A respiratory stimulant, although not commonly used due to potential side effects.
- **Adaptive Servo-Ventilation (ASV)**: Though primarily a therapy for heart failure and obstructive sleep apnea, some off-label use occurs for CSA, particularly in patients without chronic heart failure.

3. **Experimental Treatments**:
- **Phrenic Nerve Stimulation**: An implantable device that stimulates breathing by activating the phrenic nerve.
- **Advanced Positive Airway Pressure (PAP) Devices**: Newer generations of PAP devices that adapt more effectively to patients' breathing patterns are being researched.

Patients should consult their healthcare providers to explore these options, considering the potential risks and benefits.
Lifestyle Recommendations: Lifestyle recommendations for managing central sleep apnea include:

1. **Weight Management**: Maintaining a healthy weight can help reduce the severity of sleep apnea.
2. **Sleep Position**: Sleeping on your side rather than your back may help keep airways open.
3. **Avoid Alcohol and Sedatives**: These substances can relax the muscles in the throat, worsening apnea.
4. **Regular Exercise**: Engaging in regular physical activity can improve overall sleep quality and respiratory function.
5. **Smoking Cessation**: Quitting smoking can reduce inflammation and fluid retention in the airway, improving symptoms.
6. **Medical Devices**: Use continuous positive airway pressure (CPAP) or other prescribed devices to keep airways open.

It is important to consult with a healthcare provider for personalized advice and treatment options.
Medication: For central sleep apnea, certain medications might be prescribed to help manage the condition. These include:

- **Acetazolamide**: A diuretic that can help stimulate breathing.
- **Theophylline**: A medication that stimulates the respiratory system.
- **Carbonic anhydrase inhibitors**: Drugs like acetazolamide that can help manage breathing irregularities.

It's essential to consult a healthcare provider for personalized treatment and medication options.
Repurposable Drugs: Central sleep apnea (CSA) is a disorder characterized by pauses in breathing during sleep due to a lack of respiratory effort. While there is no definitive cure for CSA, some drugs used for related conditions may be repurposed to help manage its symptoms. A few examples include:

1. **Acetazolamide** - A diuretic that can stimulate respiration by inducing a mild metabolic acidosis.
2. **Theophylline** - A bronchodilator that can increase respiratory drive.
3. **Medroxyprogesterone** - A synthetic progesterone that may help enhance respiratory drive.
4. **Diamox** - Often used to treat altitude sickness; can increase the body's respiratory drive.

It's important to consult with a healthcare provider to determine the most appropriate treatment plan based on individual circumstances.
Metabolites: Central sleep apnea (CSA) is a disorder characterized by pauses in breathing during sleep due to a lack of respiratory effort. It is not directly caused by issues with metabolites or nanotechnology; rather, it is related to the central nervous system's failure to properly control breathing. However, factors such as heart failure, stroke, or conditions affecting the brainstem can influence the development of CSA. Research in these areas may sometimes involve studying metabolism and its impact on respiratory control, but these are not primary aspects of CSA.
Nutraceuticals: Nutraceuticals, or dietary supplements, have shown limited evidence in the direct treatment or management of central sleep apnea (CSA). Central sleep apnea is characterized by the brain's failure to send the appropriate signals to the muscles that control breathing. Unlike obstructive sleep apnea, which involves a physical blockage of the airway, CSA requires targeted therapies that often involve addressing the underlying causes such as heart failure or use of certain medications like acetazolamide that stimulate breathing.

However, some nutraceuticals like magnesium have been studied for their potential role in improving sleep quality and muscle function but are not specific treatments for CSA. Lifestyle changes, weight management, and addressing cardiovascular health can be supportive.

Consultation with a healthcare provider is crucial for appropriate diagnosis and management plans for CSA.
Peptides: Peptides are not currently a primary treatment or diagnostic tool for central sleep apnea. Central sleep apnea (CSA) is predominantly managed through other means such as positive airway pressure (PAP) therapy, adaptive servo-ventilation (ASV), and addressing underlying conditions like heart failure or central nervous system disorders. Research is ongoing, but peptides have not emerged as a significant factor in the current management protocols for CSA.