Boutin I, Saint-Raymond C, Borel J-C, Tamisier R, Lévy P, Pépin J-L
Laboratoire du sommeil et EFCR, pôle rééducation et physiologie , CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
Rev Pneumol Clin. 2009 Aug;65(4):261-72. doi: 10.1016/j.pneumo.2009.07.009. Epub 2009 Aug 27.
Central sleep apnea is highly prevalent in association with heart failure, some neurological diseases and chronic opioids use. There are two main categories of central sleep apnea respectively related with different underlying conditions. Some hypocapnic patients exhibit respiratory control system instability and central apnea occurs when PaCO(2) falls below the threshold for apnea during sleep. The other group are patients with chronic hypercapnia mainly in the context of neuromuscular disorders or obesity hypoventilation syndrome. All these patients should be assessed by recording blood gases, polysomnography and ventilatory responses to CO(2). Cardiologic assessment should include pro-brain natriuretic factor (pro-BNP) and cardiac echography whereas neurological examination requires brain imaging and/or electromyography. Ventilatory supports used for treating central sleep apnea are non-invasive ventilation and servo-assisted ventilation in hypercapnic and hypocapnic patients respectively.
中枢性睡眠呼吸暂停在与心力衰竭、某些神经系统疾病及长期使用阿片类药物相关的情况下极为普遍。中枢性睡眠呼吸暂停主要有两大类，分别与不同的潜在病因相关。一些低碳酸血症患者表现出呼吸控制系统不稳定，当睡眠期间动脉血二氧化碳分压（PaCO₂）降至呼吸暂停阈值以下时就会发生中枢性呼吸暂停。另一组是主要在神经肌肉疾病或肥胖低通气综合征背景下的慢性高碳酸血症患者。所有这些患者都应通过记录血气、多导睡眠图以及对二氧化碳的通气反应来进行评估。心脏评估应包括检测脑钠肽前体（pro-BNP）和心脏超声检查，而神经学检查则需要脑部成像和/或肌电图检查。用于治疗中枢性睡眠呼吸暂停的通气支持分别是针对高碳酸血症患者的无创通气和针对低碳酸血症患者的伺服辅助通气。
