Central sleep apnea (CSA) is one type of sleep apnea, a sleep disorder affecting nearly 20 million Americans. Obstructive sleep apnea is caused by a blockage of the airways, central sleep apnea is a condition in which the brain fails to signal to the muscles responsible for breath control, and mixed sleep apnea is a combination of the two types.
A new possible treatment method is underway, which consists of an implanted device to help improve central sleep apnea. Dr. William Abraham, lead researcher, said, “Central sleep apnea affects more than a third of heart failure patients and is known to make the condition worse. Unfortunately, we don’t have good treatments available for this type of apnea. Currently, positive airway pressure devices are used, but many patients don’t tolerate it well.”
In obstructive sleep apnea, opening up the airways is an effective means of treatment – along with lifestyle changes. Central sleep apnea is far more dangerous than obstructive sleep apnea, as the brain’s signals are interrupted, causing the stoppage of breathing.
Sleep medicine expert Dr. Rami Khayat added, “One of the concerning features of central sleep apnea is that these patients don’t fit the usual profile of obstructive sleep apnea. They generally don’t snore, so they’re tougher to diagnose, and the symptoms of sleepiness and fatigue overlap with symptoms associated with heart failure.”
Dr. Abraham, along with other cardiologists, tested feasibility, safety, and efficiency of the implanted device. The device resembles a pacemaker and delivers a steady signal to stimulate the diaphragm to breathe whilst asleep.
The pilot study consisted of 47 patients who were implanted with the device and evaluated for six months. The implant was placed below the collar bone and a transvenous stimulator lead was positioned near the phrenic nerve. After a one-month healing period after implantation, the device was turned on and programmed based on the patients’ sleeping patterns.
The results were found to be significant, with a 56 percent reduction in overall apnea events per hour and over 80 percent reduction in central sleep apnea.
Dr. Abraham added, “The device normalized breathing during sleep, it reduced apnea episodes and, in association with that, we saw improvements in sleepiness symptoms and patients’ quality of life. We also noted a reduction in blood pressure in patients with hypertension.”
The implanted device is now being compared with traditional treatment options in larger randomized trials. Dr. Khayat concluded, “If these initial findings bear out in the larger studies, an implantable device could be a good option for central sleep apnea patients who cannot tolerate positive airway pressure therapy.”
Central sleep apnea is less common than other types of sleep apnea and is only seen in about 10 percent of sleep apnea cases. Central sleep apnea is far more predominant among men than women. Central sleep apnea commonly affects those over the age of 60.
Central sleep apnea is when the brain’s signals are interrupted whilst asleep, causing the stoppage of breathing. The brain normally signals the breathing muscles to function, but when these signals are disrupted, it can cause the individual to stop breathing.
A number of conditions can cause the interruption of brain signals resulting in central sleep apnea, including:
There are certain factors that increase the risk of central sleep apnea, such as being male, being over the age of 65, heart disorders, stroke, brain tumor, high altitudes, opioid use, and the use of a CPAP device commonly used to treat obstructive sleep apnea.
Symptoms of central sleep apnea include:
At first, your doctor will review your medical history as well as perform a medical examination in order to rule out other health conditions that could be contributing to your symptoms. Your doctor will also schedule you for an overnight sleep test, polysomnogram, where you will be monitored through the sleeping hours. The information gathered from the sleep test will help your doctor come up with a proper diagnosis.
All the while, your doctor will also be looking for other causes for your central sleep apnea, including any medications you may be on, a mental health disorder, an underlying medical condition, substance abuse, or another sleep disorder. By treating the underlying cause of central sleep apnea, you can have improved health outcomes.
Similar to obstructive sleep apnea, a CPAP device may help treat those with central sleep apnea, too. At the same time your doctor will work to treat the cause of your central sleep apnea, be that a change in medications, treatment for substance abuse, or even treatment for any heart condition.
If the cause of central sleep apnea is high altitude, no specific treatment is required, but other associated problems may develop. In some cases, you may simply have to avoid high altitudes and in others, medication may help.
Treatments for central sleep apnea include:
Addressing medical problems: If there are underlying medical problems contributing to your central sleep apnea then it is your doctor’s goal to treat these problems as to treat your sleep apnea. For example, treating heart disease can improve central sleep apnea.
Reduction in opioid medications: If the cause of your central sleep apnea is the use of opioid medications then your doctor will want you to reduce your use of these or possibly take you off them completely.
Continuous positive airway pressure (CPAP): This is a device worn while asleep. It offers continuous air as to keep your airways open to prevent the stoppage of breathing.
Adaptive servo-ventilation (ASV): ASV is similar to CPAP as it offers continuous air. What makes ASV different is that is can adjust airflow on a breath-by-breath basis. ASV is not recommended for patients with symptomatic heart failure.
Supplemental oxygen: A variety of devices are available that offer supplemental oxygen while you sleep.
Medications: Some medications have been shown to stimulate breathing in some people with central sleep apnea, so your doctor may prescribe them. These medications are often prescribed if a person cannot tolerate airway devices.
Is it still unknown about the mortality and morbidity of central sleep apnea. Some studies have shown higher mortality and morbidity among central sleep apnea patients with congestive heart failure. Generally, if a person has their underlying medical conditions along with central sleep apnea under control than prognosis can be good and a person can live a fairly long life.
It’s important that patients adhere to their treatment plans along with living as healthy as possible to reduce risks and complications associated with central sleep apnea.