Central Sleep Apnea Syndromes Clinical Presentation

Updated: Oct 10, 2017
  • Author: Kendra Becker, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Presentation

History

Like obstructive sleep apnea, central sleep apnea frequently presents with nighttime awakenings, nocturnal hypoxia, and excessive daytime sleepiness. [17] Sometimes, bed partners report witnessed apneas and mild snoring. Patients also report nonrestorative sleep, choking, and shortness of breath.

The most common reported symptoms are insomnia, excessive daytime sleepiness and fatigue. In general, the degree of daytime hypersomnolence is less than that observed with obstructive sleep apnea, and insomnia is more prominent. The presence of insomnia may actually put these patients at increased risk of central apneas because a greater number of sleep-wake transitions provide more opportunities for an unstable breathing pattern.

Patients also may have symptoms pertaining to the underlying cause (eg, symptoms of heart failure, stroke, renal failure, Parkinson disease, or multiple system atrophy). Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and other heart failure symptoms can be seen with CSB-CSA.

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Physical Examination

In contrast to obstructive sleep apnea, no physical findings predict the presence or absence of central sleep apnea. The patients usually have a normal body habitus. Because CSB-CSA is highly prevalent in patients with congestive heart failure, signs of heart failure may be sought. [18] Sleep-disordered breathing is associated with nocturnal cardiac arrhythmias. [16] One study [19] has implicated central sleep apnea in the development of atrial fibrillation, but the methods used to differentiate central and obstructive events were not satisfactory. Patients with CSB-CSA may exhibit a periodic breathing pattern even while awake.

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