Central Sleep Apnea (CSA) disrupts normal sleep breathing pattern and hence the brain fails to give signals to breathing muscles. 

This results in pauses or reduced breathing efforts. 

Central Sleep Apnea Types as follows:   

• Primary CSA: A standalone sleep disorder and it is not related with any other medical disorder.  
• Secondary CSA: It may link to heart failure, neurological disorders, or certain medications. The causes of CSA which includes congestive heart failure, stroke, brainstem lesions, and high-altitude periodic breathing. 

CSA has prevalence which affects larger percent of population, and it is more commonly seen in heart failure patients. 

The prevalence is higher in congestive heart failure patients, and it present slightly higher in men than female.  

It is a specific pattern called Cheyne-Stokes Respiration (CSR) and this pattern is linked to heart failure.  

It is caused by increasing and decreasing respiratory effort which leads to central apnea and hyperpnea and the response of central chemoreceptors to oxygen and CO2 level plays important role. 

Heart Failure is common medical condition linked to CSA along with those changes in cardiac function, fluid balance, and baroreceptor sensitivity cause respiratory control centre disruptions. 

It is characterized by gradual respiratory effort waxing and waning which causes leading to central apneas and hyperpnea. 

CSA prognosis and Severity is determined by number of central apneas and hypopneas per hour of sleep and the higher Apnea-Hypopnea Index values impact daytime functioning and cardiovascular health. 

The management of comorbidities crucial for better prognosis and adherence to recommended treatments like PAP therapy is significantly influences prognosis. 

Age Group:   

CSA is more commonly diagnosed in adults and especially those over 65 years old are at a higher risk for developing CSA.  

The aging process can contribute to changes in the respiratory control centres in the brain. 

Body Mass Index  

Assessment of the Respiratory System 

Cardiovascular Assessment 

Neurological Examination 

Chronic Stroke Syndrome is progresses in chronic conditions like heart failure or neurological disorders and presents acutely when change in medicines or neurological events like stroke. 

Individual give response to CSA shows variation in symptoms and has similar degree of respiratory disturbance. 

Address severe underlying medical conditions such as heart failure, stroke, or opioid use that may contribute to CSAS. 

Adaptive Servo-Ventilation devices adjust airflow to stabilize breathing patterns, particularly useful for CSAS associated with Cheyne-Stokes respiration. 

Some medications, such as acetazolamide, may be prescribed to stimulate breathing, especially in certain types of CSAS. 

If the patient is not symptomatic, observation may be the only appropriate step. This may be the case in patients who have central sleep apnea during sleep-wake transition, 

No clear guidelines are available on when or whether to treat central sleep apnea in the absence of symptoms, when central sleep apnea is discovered after polysomnography (PSG). 

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In some individuals sleeping on the side rather than the back may help reduce the severity of CSA episodes. 

Follow a consistent bedtime routine which give signal to the body to wind down and go for sleep.  

In bedroom set comfortable temperature to promote good sleep.  Good sleep hygiene practices should follow to maintain a regular sleep schedule and avoid heavy meals before bedtime. 

Proper education and awareness about central sleep apnea should be provided and its related causes, and how to stop it with management strategies. 

Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort. 

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Acetazolamide: 

It inhibits the carbonic anhydrase to decrease bicarbonate formation, and results in a mild metabolic acidosis which may increase respiratory drive.  

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Zolpidem: 

It acts on a subtype of GABA receptor to increase inhibitory neurotransmission in the CNS.  

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Theophylline: 

It has a mild stimulant effect on the central respiratory centres in the brain and it is effective in cases of decreased respiratory drive during sleep. 

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The Adaptive Servo-Ventilation is a positive airway pressure therapy used to adjusts the airflow based on the patient’s respiratory patterns.  

In Bilevel Positive Airway Pressure, it delivers different pressure levels during inhalation and exhalation. 

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In the diagnosis phase, evaluation of medical history and physical examination to confirm diagnosis. 

Pharmacologic therapy is very effective in the treatment phase as it includes use of carbonic anhydrase inhibitor, phosphodiesterase inhibitor and surgical intervention. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation. 

The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.