Central sleep apnea
Central sleep apnea involves cessation of breathing during sleep, caused by problems with brain mechanisms that control breathing. (Note: This is not the more common obstructive sleep apnea caused by obesity or other problems, which results in loud snoring.)
Causes, incidence, and risk factors
Central sleep apnea is rare in people who are not seriously ill. It occurs in patients with a variety of severe and life-threatening lower brain stem lesions. The brainstem controls breathing. As a result, any disease or injury affecting this area may result in problems with normal breathing during sleep or when awake.
Conditions that can cause sentral sleep apnea include bulbar poliomyelitis, encephalitis affecting the brainstem, neurodegenerative illnesses, and stroke affecting the brainstem. Other causes include complications of surgery of the cervical spine, secondary radiation in the region of the cervical spine, severe arthritic and degenerative changes in the cervical spine and/or base of skull, or primary hypoventilation syndrome.
Cessation of breathing, especially during sleep, is the primary symptom of central sleep apnea. People with apnea of unknown cause may have frequent awakenings and complain of insomnia.
If a neurological condition is causing the apnea, it may also produce other symptoms such as difficulty swallowing, change in voice, variable weakness, or numbness throughout the body, depending on the underlying disease and what parts of the nervous system it has affected.
Signs and tests
- Respiratory function studies
- All-night polygraphic sleep monitoring
- Tests to diagnose underlying medical condition
If there is no respiratory drive as a result of an injury or disease of the brainstem, mechanical ventilation is the only treatment available to ensure continued breathing.
Injury to the brainstem is life-threatening, and prognosis is poor as a result.
Complications may result from prolonged mechanical ventilation and from the underlying disease causing the syndrome.
Calling your health care provider
Call your health care provider if you have symptoms that might indicate sleep apnea. Central sleep apnea is usually diagnosed in patients who are already severely ill.
Also see: Obstructive sleep apnea.
by Martin A. Harms, M.D.