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Causes

By Mayo Clinic staff

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:

  • Idiopathic central sleep apnea. The cause of this uncommon type of central sleep apnea isn't known. It results in repeated pauses in breathing effort and airflow.
  • Cheyne-Stokes breathing. This type of central sleep apnea is most commonly associated with congestive heart failure or stroke and is characterized by a periodic, rhythmic, 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.
  • Medical condition-induced central sleep apnea. In addition to congestive heart failure and stroke, several medical conditions may give rise to central sleep apnea. Any damage to the brainstem — which controls breathing — may impair the normal breathing process.
  • Drug-induced apnea. Taking certain medications such as opioids — for example, morphine, oxycodone or codeine — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to stop completely.
  • High-altitude periodic breathing. A Cheyne-Stokes breathing pattern may occur if you're acutely exposed to a high-enough altitude, such as an altitude greater than 15,000 feet (about 4,500 meters). The change in oxygen at this altitude is the reason for the alternating rapid breathing (hyperventilation) and underbreathing.
  • Complex sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while on treatment with continuous positive airway pressure (CPAP). This is known as complex sleep apnea because it is a combination of obstructive and central sleep apneas.
Risk factors Symptoms
References
  1. Badr MS. Central sleep apnea syndrome: Risk factors, clinical presentation, and diagnosis. http://www.uptodate.com/home/index/html. Accessed April 11, 2011.
  2. NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/sleep_apnea/sleep_apnea.htm. Accessed April 10, 2011.
  3. Javaheri S. Central sleep apnea. Clinics in Chest Medicine. 2010;31:235.
  4. Ropper AH, et al. Sleep and its abnormalities. In: Ropper AH, et al. Adams & Victor's Principles of Neurology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2009. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=54. Accessed April 8, 2011.
  5. Malhotra A. What is central sleep apnea? Respiratory Care. 2010;55:1168.
  6. Badr MS. Central sleep apnea syndrome: Pathogenesis. http://www.uptodate.com/home/index/html. Accessed April 11, 2011.
  7. Budhiraja R. Sleep-disordered breathing and cardiovascular disorders. Respiratory Care. 2010;55:1322.
  8. Collop N. Portable monitoring in obstructive sleep apnea in adults. http://www.uptodate.com/home/index/html. Accessed April 11, 2011.
  9. Millman RP. Polysomnography in obstructive sleep apnea in adults. http://www.uptodate.com/home/index/html. Accessed April 11, 2011.
  10. Your guide to healthy sleep. National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf. Accessed April 9, 2011.
  11. Central sleep apnea. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/sec05/ch061/ch061d.html. Accessed April 12, 2011.
  12. Badr MS. Central sleep apnea: Treatment. http://www.uptodate.com/home/index/html. Accessed April 11, 2011.
  13. Hastings PC, et al. Adaptive servo-ventilation in heart failure patients with sleep apnea: A real world study. International Journal of Cardiology. 2010;139:17.
  14. Randerath WJ, et al. Combined adaptive servo-ventilation and automatic positive airway pressure (anticyclic modulated ventilation) in co-existing obstructive and central sleep apnea syndrome and periodic breathing. Sleep Medicine. 2009;10:898.
  15. Ono H, et al. Sleep apnea syndrome: Central sleep apnea and pulmonary hypertension worsened during treatment with auto-CPAP, but improved by adaptive servo-ventilation. Internal Medicine. 2010;49:415.
  16. Olson EJ (expert opinion). Mayo Clinic, Rochester, Minn. April 15, 2011.
DS00995 June 16, 2011

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