Kundel Vaishnavi, Ahn Anjali, Arzt Michael, Asin Jerryll, Azarbarzin Ali, Collop Nancy, Das Aneesa, Fang James C, Khayat Rami, Penzel Thomas, Pépin Jean-Louis, Sharma Sunil, Suurna Maria V, Tallavajhula Sudha, Malhotra Atul
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
J Clin Sleep Med. 2025 Feb 1;21(2):405-416. doi: 10.5664/jcsm.11424.
Central sleep apnea (CSA) is commonly encountered among patients with sleep-disordered breathing; however, its clinical consequences are less well-characterized. The senior author (A.M.) therefore convened an expert panel to discuss the common presentations of CSA, as well as challenges and knowledge gaps in the diagnosis and management of CSA. The panel identified several key research priorities essential for advancing our understanding of the disorder. Within the diagnostic realm, panel members discussed the utility of multinight assessments and importance of the development and validation of novel metrics and automated assessments for differentiating central vs obstructive hypopneas, such that their impact on clinical outcomes and management may be better evaluated. The panel also discussed the current therapeutic landscape for the management of CSA and agreed that therapies should primarily aim to alleviate sleep-related symptoms, after optimizing treatment to address the underlying cause. Most importantly, the panel concluded that there is a need to further investigate the clinical consequences of CSA, as well as the implications of therapy on clinical outcomes, particularly among those who are asymptomatic. Future research should focus on endo-phenotyping central events for a better mechanistic understanding of the disease, validating novel diagnostic methods for implementation in routine clinical practice, as well as the use of combination therapy and comparative effectiveness trials in elucidating the most efficacious interventions for managing CSA.
Kundel V, Ahn A, Arzt M, et al. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. 2025;21(2):405-416.
中枢性睡眠呼吸暂停(CSA)在睡眠呼吸障碍患者中很常见;然而,其临床后果的特征尚不明确。因此,资深作者(A.M.)召集了一个专家小组,讨论CSA的常见表现,以及CSA诊断和管理中的挑战与知识空白。该小组确定了几个关键研究重点,对于推进我们对该疾病的理解至关重要。在诊断领域,小组成员讨论了多晚评估的效用,以及开发和验证用于区分中枢性与阻塞性呼吸暂停低通气的新指标和自动评估的重要性,以便更好地评估它们对临床结果和管理的影响。该小组还讨论了当前CSA管理的治疗现状,并一致认为治疗应主要旨在缓解与睡眠相关的症状,前提是优化治疗以解决潜在病因。最重要的是,该小组得出结论,有必要进一步研究CSA的临床后果,以及治疗对临床结果的影响,特别是在无症状患者中。未来的研究应专注于对中枢性事件进行内表型分析,以更好地从机制上理解该疾病,验证可在常规临床实践中应用的新诊断方法,以及使用联合治疗和比较有效性试验来阐明治疗CSA最有效的干预措施。
Kundel V, Ahn A, Arzt M等。中枢性睡眠呼吸暂停的见解、建议和研究重点:专家小组报告。2025;21(2):405 - 416。