a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.
b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France.
Expert Rev Respir Med. 2019 Jun;13(6):545-557. doi: 10.1080/17476348.2019.1604226. Epub 2019 Apr 24.
: Central sleep apnea (CSA) syndrome has gained a considerable interest in the sleep field within the last 10 years. It is overrepresented in particular subpopulations such as patients with stroke or heart failure. Early detection and diagnosis, as well as appropriate treatment of central breathing disturbances during sleep remain challenging. : Based on a systematic review of CSA in adults the clinical evidence and polysomnographic patterns useful for discerning central from obstructive events are discussed. Current therapeutic indications of CSA and perspectives are presented, according to the type of respiratory disturbances during sleep, alterations in blood gases and ventilatory control. : The precise identification of central events during polysomnographic recording is mandatory. Therapeutic choices for CSA depend on the typology of respiratory disturbances observed by polysomnography, changes in blood gases and ventilatory control. In CSA with normocapnia and ventilatory instability, adaptive servo-ventilation is recommended. In CSA with hypercapnia and/or rapid-eye movement sleep hypoventilation, non-invasive ventilation is required. Further studies are required as strong evidence is lacking regarding the long-term consequences of CSA and the long-term impact of current treatment strategies.
: 中枢性睡眠呼吸暂停（CSA）综合征在过去 10 年中引起了睡眠领域的极大关注。它在某些特定人群中更为常见，如中风或心力衰竭患者。早期发现和诊断以及适当治疗睡眠期间的中枢性呼吸障碍仍然具有挑战性。: 本文通过对成人 CSA 的系统回顾，讨论了用于辨别中枢性与阻塞性事件的临床证据和多导睡眠图模式。根据睡眠期间呼吸障碍的类型、血气变化和通气控制，介绍了 CSA 的当前治疗指征和观点。: 多导睡眠图记录中必须精确识别中枢事件。CSA 的治疗选择取决于多导睡眠图观察到的呼吸障碍类型、血气变化和通气控制的改变。在伴有正常碳酸血症和通气不稳定的 CSA 中，建议使用适应性伺服通气。在伴有高碳酸血症和/或快速眼动睡眠通气不足的 CSA 中，需要使用无创通气。由于缺乏 CSA 的长期后果和当前治疗策略的长期影响的强有力证据，因此需要进一步研究。
