Overview

Central sleep apnea is a disorder in which your breathing repeatedly stops and starts during sleep.

Central sleep apnea occurs because your brain doesn't send proper signals to the muscles that control your breathing. This condition is different from obstructive sleep apnea, in which you can't breathe normally because of upper airway obstruction. Central sleep apnea is less common than obstructive sleep apnea.

Central sleep apnea may occur as a result of other conditions, such as heart failure and stroke. Sleeping at a high altitude also may cause central sleep apnea.

Treatments for central sleep apnea may involve treating existing conditions, using a device to assist breathing or using supplemental oxygen.

Symptoms

Common signs and symptoms of central sleep apnea include:

  • Observed episodes of stopped breathing or abnormal breathing patterns during sleep
  • Abrupt awakenings accompanied by shortness of breath
  • Shortness of breath that's relieved by sitting up
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Chest pain at night
  • Difficulty concentrating
  • Mood changes
  • Morning headaches
  • Snoring
  • Lower tolerance for exercise

Although snoring indicates some degree of airflow obstruction, snoring also may be heard in the presence of central sleep apnea. However, snoring may not be as prominent with central sleep apnea as it is with obstructive sleep apnea.

When to see a doctor

Consult a medical professional if you experience — or if your partner observes — any signs or symptoms of central sleep apnea, particularly the following:

  • Shortness of breath that awakens you from sleep
  • Intermittent pauses in your breathing during sleep
  • Difficulty staying asleep
  • Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving

Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness may be due to other disorders, such as not allowing yourself time to get enough sleep at night (chronic sleep deprivation), sudden attacks of sleep (narcolepsy) or obstructive sleep apnea.

Causes

Central sleep apnea occurs when your brain fails to transmit signals to your breathing muscles.

Central sleep apnea can be caused by a number of conditions that affect the ability of your brainstem — which links your brain to your spinal cord and controls many functions such as heart rate and breathing — to control your breathing.

The cause varies with the type of central sleep apnea you have. Types include:

  • Cheyne-Stokes breathing. This type of central sleep apnea is most commonly associated with congestive heart failure or stroke.

    Cheyne-Stokes breathing is characterized by a gradual increase and then decrease in breathing effort and airflow. During the weakest breathing effort, a total lack of airflow (central sleep apnea) can occur.

  • Drug-induced apnea. Taking certain medications such as opioids — including morphine (Ms Contin, Kadian, others), oxycodone (Roxicodone, Oxycontin, others) or codeine — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to temporarily stop completely.
  • High-altitude periodic breathing. A Cheyne-Stokes breathing pattern may occur if you're exposed to a very high altitude. The change in oxygen at this altitude is the reason for the alternating rapid breathing (hyperventilation) and underbreathing.
  • Treatment-emergent central sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for their sleep apnea treatment. This condition is known as treatment-emergent central sleep apnea and is a combination of obstructive and central sleep apneas.
  • Medical condition-induced central sleep apnea. Several medical conditions, including end-stage kidney disease and stroke, may give rise to central sleep apnea of the non-Cheyne-Stokes variety.
  • Idiopathic (primary) central sleep apnea. The cause of this uncommon type of central sleep apnea isn't known.

Risk factors

Certain factors put you at increased risk of central sleep apnea:

  • Sex. Males are more likely to develop central sleep apnea than are females.
  • Age. Central sleep apnea is more common among older adults, especially adults older than age 65, possibly because they may have other medical conditions or sleep patterns that are more likely to cause central sleep apnea.
  • Heart disorders. People with irregular heartbeats (atrial fibrillation) or whose heart muscles don't pump enough blood for the body's needs (congestive heart failure) are at greater risk of central sleep apnea.
  • Stroke, brain tumor or a structural brainstem lesion. These brain conditions can impair the brain's ability to regulate breathing.
  • High altitude. Sleeping at an altitude higher than you're accustomed to may increase your risk of sleep apnea. High-altitude sleep apnea is no longer a problem a few weeks after returning to a lower altitude.
  • Opioid use. Opioid medications may increase the risk of central sleep apnea.
  • CPAP. Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP). This condition is known as treatment-emergent central sleep apnea. It is a combination of obstructive and central sleep apneas.

    For most people, treatment-emergent central sleep apnea goes away with continued use of a CPAP device. Other people may be treated with a different kind of positive airway pressure therapy.

Complications

Central sleep apnea is a serious medical condition. Some complications include:

  • Fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with central sleep apnea often experience severe fatigue, daytime drowsiness and irritability.

    You may have difficulty concentrating and find yourself falling asleep at work, while watching television or even when driving.

  • Cardiovascular problems. In addition, sudden drops in blood oxygen levels that occur during central sleep apnea may adversely affect heart health.

    If there's underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) worsen prognosis and increase the risk of abnormal heart rhythms.

Sleep apnea, central care at Mayo Clinic

June 25, 2019
References
  1. Ropper AH, et al. Sleep and its abnormalities. In: Adams and Victor's Principles of Neurology. 11th ed. New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Accessed April 17, 2019.
  2. Badr MS. Central sleep apnea: Risk factors, clinical presentation, and diagnosis. https://www.uptodate.com/contents/search. Accessed April 17, 2019.
  3. Jameson JL, et al., eds. Sleep apnea. In: Harrison's Principles of Internal Medicine. 20th ed. New York, N.Y.: The McGraw-Hill Companies; 2018. https://accessmedicine.mhmedical.com. Accessed April 17, 2019.
  4. Central sleep apnea. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/central-sleep-apnea?query=Central sleep apnea#. Accessed April 17, 2019.
  5. Parthasarathy S. Treatment-emergent central sleep apnea. https://www.uptodate.com/contents/search. Accessed April 17, 2019.
  6. Badr MS. Central sleep apnea: Treatment. https://www.uptodate.com/contents/search. Accessed April 17, 2019.
  7. Ding N, et al. Transvenous phrenic nerve stimulation. Journal of Thoracic Disease. 2018;10:2005.
  8. Abraham WT, et al. Identification and treatment of central sleep apnoea: Beyond Serve-HF. Cardiac Failure Review. 2018;4:50.
  9. Sleep apnea. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea. Accessed April 2, 2019.
  10. Aurora RN, et al. Updated adaptive servo-ventilation recommendations for the 2012 AASM Guideline: "The treatment of central sleep apnea syndromes in adults: Practice parameters with an evidence-based literature review and meta-analyses." Journal of Clinical Sleep Medicine. 2016;12:757.
  11. AskMayoExpert. Central sleep apnea. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
  12. Kryger MH, et al., eds. Central sleep apnea: Diagnosis and management. In: Principles and Practice of Sleep Medicine. 6th ed. St. Louis, Mo.: Elsevier Saunders; 2017. https://www.clinicalkey.com. Accessed April 17, 2019.
  13. Hines RL, et al., eds. Sleep-related breathing disorders. In: Stoelting's Anesthesia and Co-Existing Disease. 7th ed. Philadelphia, Pa.: Elvesier; 2018. https://www.clinicalkey.com. Accessed April 12, 2019.
  14. Kramer NR, et al. Overview of polysomnography is adults. https://www.uptodate.com/contents/search. Accessed April 12, 2019.
  15. Selim BJ, et al. Management of sleep apnea syndromes in heart failure. Sleep Medicine Clinics. 2017;12:107.
  16. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. April 30, 2019.