Central Sleep Apnea (Csa)
What is Central Sleep Apnea (Csa)
Central sleep apnea (CSA) Suspension of obstructive sleep apnea (OSA) are much less common, and its incidence is about 5% of the incidence of OSA. High-risk groups in patients with congestive heart failure.
Symptoms of Central Sleep Apnea (Csa)
Similar clinical manifestations of patients with central sleep apnea (CSA) in patients with OSA, central sleep apnea (CSA) performance to excessive sleepiness performance for the poor quality of sleep at night and during the day. I have informally proposed CSA in patients with insomnia incidence is higher than that in patients with OSA. The headaches are common symptoms. Patients often have evidence of congestive heart failure, can also be seen in patients with obesity and impaired memory or cognitive performance. See part discusses the symptoms of obstructive sleep apnea syndrome.
Course of the disease and complications:
Did not inquire into any article on the prognosis of CSA in the U.S. National Library of Medicine's PubMed online. Suspended central sleep apnea (CSA) in patients may be complicated by central sleep apnea (CSA), the performance of daytime fatigue, insomnia, sleep disturbances, and hypoxia-related symptoms. CSA in patients with obstructive sleep apnea patients, CSA no corresponding intrathoracic pressure changes or sympathetic dysfunction, thus avoiding the problem of cardiovascular disease like OSA as concurrent.
What Causes Central Sleep Apnea (Csa)
Pathophysiology of central sleep apnea (CSA) and OSA, OSA patients with respiratory efforts against a closed airway, in patients with central sleep apnea, apnea reason is because there is no irritation to the respiratory signal. This phenomenon is due to an error feedback loop exists between the respiratory effort and chemoreceptor Erzhi. The cause of central sleep apnea (CSA) is over-sensitive chemoreceptors oxygen and (or) carbon dioxide; decrease in cardiac output, arterial blood flow slows down, the oxygen / carbon dioxide exchange (O2/CO2); on abnormal normal feedback signal processing (central respiratory drive impaired); well as abnormal environmental factors, such as high-altitude environment, these factors prompted patients with central sleep apnea. The conscious status change, i.e. the transition from the awake state to the sleep state can be changed while the signal of the feedback loop. Central sleep apnea can be divided into several subtypes: high altitude periodic breathing, Cheyne-Stokes tidal breathing, obesity hypoventilation syndrome and anesthesia-induced central apnea. From the pathophysiological point of view, the CSA can be divided into the type of hypercapnia and non-hypercapnia. Hypercapnic CSA, including narcotic-induced respiratory drive passivation patients and obese syndrome in patients with poor ventilation, which is defined as obese (BMI> 3O) and in the absence of other reasons could explain the patient wakefulness PCO2> 45mmHg. Similarly, patients with impaired neuromuscular function of the reaction of the respiratory center drive may also decrease. High non-hypercapnic central sleep apnea (CSA), the typical breathing crescendo and diminuendo Cheyne-Stokes the tidal breathing patients and patients with respiratory rate changing in the respiratory cycle, this type is particularly common in patients with heart failure. As well as a small amount of population suffering from idiopathic central apnea syndrome. Overlap exists between OSA and CSA at both abnormal breathing control, and also there is no rigid criteria for the classification of dividing these two lesions. Some patients had OSA treatment, can be found by polysomnography plethysmometer checking often coexist in patients with CSA, before patients are not diagnosed with CSA.
Tests and Diagnosis for Central Sleep Apnea (Csa)
With the diagnosis of obstructive sleep apnea hypopnea syndrome, central sleep apnea (CSA), the gold standard for diagnosis is also a multi-polysomnography Fig. Cheyne-Stokes breathing pattern or non-blocking event intervention sudden apnea is easily diagnosed with CSA, this ventilatory failure. Arterial blood gas analysis can be found hypercapnia. Assess whether patients with congestive heart failure (echocardiography, etc.) and the re-examination of the patient's medication, both useful for the diagnosis of the patient's significance.
Imaging: The imaging technology is not used in the assessment of central sleep apnea (CSA) in patients with central sleep apnea (GSA) must method, but is used to evaluate and judge other related diseases.
Laboratory tests: Arterial blood gas analysis and thyroid function tests may be helpful in the diagnosis of the cause of the patient's.
Treatments of Central Sleep Apnea (Csa)
Main CSA etiology. The best method of treatment of central sleep apnea (CSA) is effective in the treatment of heart failure, heart failure and CSA resynchronization therapy is beneficial. Atrial overdrive pacing may suspend the treatment of patients with central respiratory help, but does not apply to the treatment of patients with obstructive sleep apnea. CSA and patients using hypnotic agent, then reduce the use of hypnotic agents can reduce the CSA. Suspended for persistent central sleep apnea (CSA) patients, the integrity of the feedback loop between recovery chemoreceptor respiratory drive hub to treatment. Oxygen therapy can reduce the phenomenon caused by the instability of the patient's respiratory chemoreceptor to hypoxia overly sensitive. Adding a very small amount of carbon dioxide in the air inhaled, can stimulate chemoreceptors, it has been confirmed in a number of trials. Acetazolamide to change the acid-base equilibrium in the body to stimulate the patient's breathing, the treatment of central sleep apnea (CSA) drugs that directly stimulate the respiratory center can also be used, such as progesterone, but male patients may be because of its adverse reaction very opposed to the use of this drug. Continuous positive airway pressure (CPAP) treatment for some patients, but the mechanism is unclear. BiPAP can directly improve the ventilation, but if you use an incorrect method, carbon dioxide partial pressure drops too fast, but also enabled increased respiratory instability. In the United States, the Centers for Medicare and Medicaid Payout Services (CMS) and other insurance companies, the use of CSA in patients with NIPPV strict guidelines. Clinicians should be familiar with these guidelines and local regulations and policies.