Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\26101651
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Thorac+Dis
2015 ; 7
(5
): 930-7
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Central sleep apnoea-a clinical review
#MMPMID26101651
Muza RT
J Thorac Dis
2015[May]; 7
(5
): 930-7
PMID26101651
show ga
Central sleep apnoea (CSA) is characterised by recurrent apnoeas during sleep
with no associated respiratory effort. It mostly results from withdrawal of the
wakefulness drive in sleep leaving ventilation under metabolic control. A
detailed physiological understanding of the control of breathing in wakefulness
and sleep is essential to the understanding of CSA. It encompasses a diverse
group of conditions with differing aetiologies and pathophysiology. Likewise
treatment varies according to underlying aetiology. Some of the conditions such
as idiopathic (primary) CSA (ICSA) are relatively rare and benign. On the other
hand Cheyne-Stokes breathing (CSB) pattern is quite common in patients with heart
failure and might be a prognostic indicator of poor outcome. Unfortunately modern
medical management of heart failure does not seem to have significantly reduced
the prevalence of CSA in this group. Since the adoption of positive airway
pressure (PAP) as a common treatment modality of obstructive sleep apnoea (OSA),
complex CSA has been increasingly observed either as treatment emergent or
persistent CSA. Depending on the particular condition, various treatment
strategies have been tried in the past two decades which have included hypnotic
therapy, respiratory stimulants, judicious administration of carbon dioxide,
oxygen therapy, PAP and bi-level ventilatory support with a backup rate. In the
past decade adaptive servo ventilation (ASV) has been introduced with much
promise. Various studies have shown its superiority over other treatment
modalities. Ongoing long term studies will hopefully shed more light on its
impact on cardiovascular morbidity and mortality. Other rare forms are still
poorly understood and treatments remain suboptimal.