Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States.
Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States.
Handb Clin Neurol. 2022;189:93-103. doi: 10.1016/B978-0-323-91532-8.00011-2.
Central apnea syndrome is a disorder with protean manifestations and concomitant conditions. It can occur as a distinct clinical entity or as part of another clinical syndrome. The pathogenesis of central sleep apnea (CSA) varies depending on the clinical condition. Sleep-related withdrawal of the ventilatory drive to breathe is the common denominator among all cases of central apnea, whereas hypocapnia is the final common pathway leading to apnea in the majority of central apnea. Medical conditions most closely associated with CSA include heart failure, stroke, spinal cord injury, and opioid use, among others. Nocturnal polysomnography is the standard diagnostic method, including measurement of sleep and respiration. The latter includes detection of flow, measurement of oxyhemoglobin saturation and detection of respiratory effort. Management strategy incorporates clinical presentation, associated conditions, and the polysomnographic findings in an individualized manner. The pathophysiologic heterogeneity may explain the protean clinical manifestations and the lack of a single effective therapy for all patients. While research has enhanced our understanding of the pathogenesis of central apnea, treatment options are extrapolated from treatment of obstructive sleep apnea. Co-morbid conditions and concomitant obstructive sleep apnea influence therapeutic approach significantly. Therapeutic options include positive pressure therapy, pharmacologic therapy, and supplemental Oxygen. Continuous positive airway pressure (CPAP) is the initial standard of care, although the utility of other modes of positive pressure therapy, as well as pharmacotherapy and device-based therapies, are currently being investigated.
中枢性睡眠呼吸暂停综合征是一种表现多样且伴有多种合并症的疾病。它可以作为一个独特的临床实体存在，也可以作为另一种临床综合征的一部分。中枢性睡眠呼吸暂停（CSA）的发病机制因临床情况而异。与呼吸驱动相关的睡眠相关性呼吸暂停是所有中枢性呼吸暂停的共同特征，而低碳酸血症是导致大多数中枢性呼吸暂停的最终共同途径。与 CSA 最密切相关的疾病包括心力衰竭、中风、脊髓损伤和阿片类药物使用等。夜间多导睡眠图是标准的诊断方法，包括睡眠和呼吸的测量。后者包括气流检测、氧合血红蛋白饱和度测量和呼吸努力检测。管理策略包括根据临床表现、合并症和多导睡眠图结果进行个体化治疗。病理生理学的异质性可能解释了其多样的临床表现以及缺乏对所有患者都有效的单一治疗方法。尽管研究已经增强了我们对中枢性呼吸暂停发病机制的理解，但治疗选择是从阻塞性睡眠呼吸暂停的治疗中推断出来的。合并症和并存的阻塞性睡眠呼吸暂停显著影响治疗方法。治疗选择包括正压治疗、药物治疗和补充氧气。持续气道正压通气（CPAP）是初始的标准治疗方法，尽管其他正压治疗模式、药物治疗和基于设备的治疗方法的应用正在研究中。
