Central Sleep
Apnea
What is central sleep
apnea and what causes
it?
Central sleep apnea
(CSA)
occurs when the brain
does not send the
signal to breathe to
the muscles of
breathing. This
usually occurs in
infants or in adults
with heart disease,
cerebrovascular
disease, or
congenital diseases
but also can be
caused by some
medications and high
altitudes.
Central sleep apnea
may occur in
premature infants
(born before 37 weeks
of gestation) or in
full term infants. It
is defined as apneas
lasting more than 20
seconds, usually with
a change in the heart
rate, a reduction in
blood oxygen, or
hypotonia (general
relaxation of the
body’s muscles).
These children often
will require an apnea
monitor that sounds
an alarm when apneas
occur. Central sleep
apnea is not the same
thing as sudden
infant death syndrome
(SIDS).
Under normal
circumstances, the
brain monitors
several things to
determine how often
to breathe. If it
senses a lack of
oxygen or an excess
of carbon dioxide in
the blood, it will
speed up breathing.
The increase in
breathing increases
the oxygen and
decreases the carbon
dioxide in blood.
Some people with
heart disease have an
increase in carbon
dioxide in their
blood at all times.
When there is a
chronic (long term)
increase in blood
carbon dioxide, the
brain starts to
ignore the oxygen
level and monitors
the blood carbon
dioxide level to
determine when to
take the next breath.
The control of
breathing also
becomes slower to
respond to changes in
carbon dioxide
levels. Thus, if a
person takes more or
deeper breaths and
“blows off” carbon
dioxide, the drive to
breathe decreases,
and the rate of
breathing decreases.
After a while, the
carbon dioxide builds
back up in the blood,
and the rate of
breathing increases.
The brain, slow to
adjust, continues to
signal for more rapid
breathing until the
carbon dioxide level
drops too low.
Breathing then slows
down or stops until
the carbon dioxide
level rises again.
This pattern of
abnormal breathing is
called Cheyne-Stokes
breathing (after the
men who described
it). It is
characterized by
repetitive cycles of
fast breathing
followed by slow
breathing and apnea.
This breathing
pattern happens when
the person is awake
or asleep, but
becomes more of a
problem when asleep.
Some patients with
heart failure have
central sleep apnea
associated with a
Cheyne-Stokes pattern
of breathing.
Central sleep apnea
usually occurs in
adults with other
medical problems. In
infants, it usually
occurs with
prematurity or other
congenital disorders.
In both patient
groups it is usually
suspected by the
primary physician.
Central sleep apnea
can be diagnosed with
a sleep study or
overnight monitoring
while the patient is
in the hospital. In
infants, central
sleep apnea is
treated with an apnea
alarm. This alarm
monitors the infant’s
breathing with
sensors and sounds a
loud noise when the
infant experiences an
apnea. The alarm
usually wakes the
infant and the
parents. Most infants
usually “out-grow”
the central apnea
episodes, so the
alarm monitoring is
stopped after the
episodes resolve. In
infants with other
congenital problems,
apnea monitoring may
be needed for a
longer period. In
adults with central
sleep apnea, the
apneas are treated by
treating the
underlying heart
disease, medication
interaction, high
altitude, or other
primary problem
If you
think you or a
loved one may
have
symptoms of a
sleep disorder,
please
contact us
today.
Help
is available!
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