Javaheri Shahrokh, Giannoni Alberto, Somers Virend K, Malhotra Atul, Emdin Michele, Costanzo Maria R
Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, OH, USA.
Health Science Interdisciplinary Center, Scuola Superiore Sant'anna, Pisa, Italy.
Sleep. 2025 Mar 11;48(3). doi: 10.1093/sleep/zsae307.
Central sleep apnea, a rare polysomnographic finding in the general population, is prevalent in certain cardiovascular conditions including systolic and diastolic left ventricular dysfunction, atrial fibrillation, coronary artery disease, carotid artery stenosis, stroke, and use of certain cardiac-related medications. Polysomnographic findings of central sleep apnea with adverse cardiovascular impacts include nocturnal hypoxemia and arousals, which can lead to increased sympathetic activity both at night and in the daytime. Among cardiovascular diseases, central sleep apnea is most prevalent in patients with left ventricular systolic dysfunction; a large study of more than 900 treated patients has shown a dose-dependent relationship between nocturnal desaturation and mortality. Multiple small randomized controlled trials have shown mitigation of sympathetic activity when central sleep apnea is treated with nocturnal oxygen, continuous positive airway pressure, and adaptive servoventilation. However, two early randomized controlled trials with positive airway pressure devices have shown either a neutral effect on survival or excess premature mortality in the active treatment arm, compared to untreated central sleep apnea. In contrast, the results of the most recent trial using an advanced adaptive servoventilation device showed improved quality of life and no signal for mortality suggesting that treatment of central sleep apnea was at least safe. In addition to positive airway pressure devices, multiple medications have been shown to improve central sleep apnea, but no long-term trials of pharmacologic therapy have been published. Currently, phrenic nerve stimulation is approved for the treatment of central sleep apnea, and the results of a randomized controlled trial showed significant improvement in sleep metrics and quality of life.
中枢性睡眠呼吸暂停在普通人群中是一种罕见的多导睡眠图表现，但在某些心血管疾病中较为普遍，包括左心室收缩和舒张功能障碍、心房颤动、冠状动脉疾病、颈动脉狭窄、中风以及使用某些与心脏相关的药物。伴有不良心血管影响的中枢性睡眠呼吸暂停的多导睡眠图表现包括夜间低氧血症和觉醒，这可能导致夜间和白天交感神经活动增加。在心血管疾病中，中枢性睡眠呼吸暂停在左心室收缩功能障碍患者中最为普遍；一项对900多名接受治疗的患者进行的大型研究表明，夜间血氧饱和度降低与死亡率之间存在剂量依赖关系。多项小型随机对照试验表明，使用夜间吸氧、持续气道正压通气和适应性伺服通气治疗中枢性睡眠呼吸暂停时，交感神经活动会减轻。然而，两项使用气道正压通气设备的早期随机对照试验表明，与未经治疗的中枢性睡眠呼吸暂停相比，积极治疗组对生存率要么无影响，要么过早死亡率过高。相比之下，最近一项使用先进的适应性伺服通气设备的试验结果显示，生活质量得到改善，且无死亡率信号，这表明中枢性睡眠呼吸暂停的治疗至少是安全的。除了气道正压通气设备外，多种药物已被证明可改善中枢性睡眠呼吸暂停，但尚未发表药物治疗的长期试验。目前，膈神经刺激已被批准用于治疗中枢性睡眠呼吸暂停，一项随机对照试验的结果显示睡眠指标和生活质量有显著改善。
