Central sleep apnea: Pathogenesis
- M Safwan Badr, MD
M Safwan Badr, MD
- Section Editor — Sleep Related Breathing Disorders
- Professor and Chief, Pulmonary Critical Care and Sleep Medicine
- Wayne State University School of Medicine
Central apneas are periods of absent airflow due to lack of respiratory effort. They occur when inhibitory input to the respiratory center of the brain exceeds excitatory input, which may occur during sleep because sleep abolishes wakefulness-related excitatory input. Recurrent central apneas are the hallmark feature of central sleep apnea (CSA).
In this topic review, the pathogenesis of central sleep apnea is discussed. The definition of a central apnea is provided separately. The etiologies, clinical presentation, diagnosis, treatment, and outcome of CSA are also discussed separately. (See "Polysomnography in the evaluation of sleep-disordered breathing in adults" and "Central sleep apnea: Risk factors, clinical presentation, and diagnosis" and "Central sleep apnea: Treatment".)
CENTRAL APNEA DUE TO HYPERVENTILATION
Respiration during non-rapid eye movement (NREM) sleep is critically dependent on chemical influences, especially arterial carbon dioxide tension (PaCO2). Central apnea results if arterial PaCO2 is lowered below a highly sensitive "apneic threshold" (waveform 1) .
Central apnea is best conceptualized as the outcome to a sequence of events:
●First, any of a variety of stimuli induce hyperpnea. As an example, hypoxia (eg, due to secretions or decreased lung volumes) is a common trigger of hyperpnea during sleep [2-5].
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