White D P
Med Clin North Am. 1985 Nov;69(6):1205-19. doi: 10.1016/s0025-7125(16)30983-x.
Central sleep apnea is a disorder characterized by apneic episodes during sleep with no associated ventilatory effort. More commonly than not these apneas are seen in patients who also have obstructive and mixed events. Although patients with this disorder frequently complain of insomnia and depression, frank hypersomnolence is rarely encountered. As these complaints are common ones seen in numerous clinical situations, and since sleep studies are rarely conducted to investigate their etiology, the true incidence of central sleep apnea has not been determined. The etiology of central apnea remains unknown, although the association between these breathing events and a number of other disease processes has increased our understanding of the disorder. Central apneas during sleep commonly occur after hyperventilation with the associated hypocapnic alkalosis. This occurs at high altitude when hyperventilation is induced by hypoxia and at sea level when spontaneous nocturnal hyperventilation occurs. This suggests that PCO2 is the primary stimulus to ventilation during sleep and that loss of this drive, as occurs with hypocapnia, may produce dysrhythmic breathing. Patients with complete absence of ventilatory chemosensitivity such as occurs with Ondine's curse (central alveolar hypoventilation) or the obesity-hypoventilation syndrome may also have central apneas. For reasons that remain unexplained, central sleep apnea is commonly seen in patients with congestive heart failure, nasal obstruction, and certain neurologic disorders. However, in most patients with central sleep apnea no obvious cause or association can be found. The treatment of this disorder is not entirely satisfactory. If it is severe, mechanical ventilation during sleep can be provided by any one of a number of techniques. However, for the patient who simply complains of insomnia and is found to have a moderate number of central apneas, the treatment choices are limited. Acetazolamide has been shown to decrease central apneas during short-term use, but results have been variable with prolonged administration. Other ventilatory stimulants seem to have little efficacy. Interestingly, oxygen administration has been shown to reduce central apneas considerably in a number of studies, although the explanation for its success is unknown. Central sleep apnea therefore remains a relatively rare disorder whose etiology is not fully understood and whose treatment is not completely satisfactory.
中枢性睡眠呼吸暂停是一种以睡眠期间出现呼吸暂停发作且无相关通气努力为特征的疾病。这些呼吸暂停在同时存在阻塞性和混合性事件的患者中更为常见。虽然患有这种疾病的患者经常抱怨失眠和抑郁，但很少出现明显的嗜睡。由于这些症状在许多临床情况下都很常见，而且很少进行睡眠研究来调查其病因，因此中枢性睡眠呼吸暂停的真实发病率尚未确定。中枢性呼吸暂停的病因仍然不明，尽管这些呼吸事件与许多其他疾病过程之间的关联增进了我们对该疾病的理解。睡眠期间的中枢性呼吸暂停通常发生在过度通气及相关的低碳酸血症性碱中毒之后。这在高海拔地区因缺氧引起过度通气时以及海平面夜间自发性过度通气时都会发生。这表明二氧化碳分压是睡眠期间通气的主要刺激因素，而这种驱动力的丧失，如在低碳酸血症时发生的情况，可能会导致呼吸节律异常。完全没有通气化学敏感性的患者，如患有翁丁氏咒诅（中枢性肺泡低通气）或肥胖低通气综合征的患者，也可能出现中枢性呼吸暂停。出于尚无法解释的原因，中枢性睡眠呼吸暂停在充血性心力衰竭、鼻阻塞和某些神经系统疾病患者中很常见。然而，在大多数中枢性睡眠呼吸暂停患者中，找不到明显的病因或关联。这种疾病的治疗并不完全令人满意。如果病情严重，可以通过多种技术中的任何一种在睡眠期间提供机械通气。然而，对于仅仅抱怨失眠且被发现有中度数量中枢性呼吸暂停的患者，治疗选择有限。乙酰唑胺已被证明在短期使用时可减少中枢性呼吸暂停，但长期给药的结果不一。其他通气刺激剂似乎效果不佳。有趣的是，在一些研究中，吸氧已被证明可显著减少中枢性呼吸暂停，尽管其成功的原因尚不清楚。因此，中枢性睡眠呼吸暂停仍然是一种相对罕见的疾病，其病因尚未完全了解，治疗也不完全令人满意。
