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::'''Physiologic effects of central apnea:''' During central apneas, the central respiratory drive is absent, and the brain does not respond to changing blood levels of the respiratory gases. No breath is taken despite the normal signals to inhale. The immediate effects of central sleep apnea on the body depend on how long the failure to breathe endures. At worst, central sleep apnea may cause sudden death. Short of death, drops in blood oxygen may trigger seizures, even in the absence of epilepsy. In people with epilepsy, the hypoxia caused by apnea may trigger seizures that had previously been well controlled by medications. In other words, a seizure disorder may become unstable in the presence of sleep apnea. In adults with coronary artery disease, a severe drop in blood oxygen level can cause angina, arrhythmias, or heart attacks (myocardial infarction). Longstanding recurrent episodes of apnea, over months and years, may cause an increase in carbon dioxide levels that can change the pH of the blood enough to cause a metabolic acidosis.
==Types of Central Sleep Apnea==
The International Classification of Sleep Disorders, Second Edition (ICSD-2) distinguishes 5 subtypes of central sleep apnea syndromes (CSAS) in adults. Review of the literature suggests that there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242685/ The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses]
The American Academy of Sleep Medicine (AASM) identifies 6 causes for central sleep apnea syndrome (CSAS). (1) Primary Central Sleep Apnea, (2) Central Sleep Apnea Due to Cheyne Stokes Breathing Pattern, (3) Central Sleep Apnea Due to unknown Medical Condition Not Cheyne Stokes, (4) Central Sleep Apnea Due to High-Altitude Periodic Breathing, (5) Central Sleep Apnea Due to Drug or Substance, and (6) Primary Sleep Apnea of Infancy. It should be noted that category (3) is the very common idiopathic CSAS and can include individuals that develop CSA subsequent to initiating CPAP therapy. This treatment onset central sleep apnea is generally not related to any known medical condition, and is the result of increased ventilation or hyperventilation in response to use of CPAP or BPAP.
==Diagnosis==
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