Last updated December 20, 2021

Treatment of Central Sleep Apnea Syndromes in Adults

Primary CSAS

Positive airway pressure therapy may be considered for the treatment of primary CSAS. (OPTION)
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Acetazolamide has limited supporting evidence but may be considered for the treatment of primary CSAS. (OPTION)
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The use of zolpidem and triazolam may be considered for the treatment of primary CSAS only if the patient does not have underlying risk factors for respiratory depression. (OPTION)
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CSAS Due to Congestive Heart Failure (CHF) Including Cheyne Stokes Breathing Pattern (CSBP) and Not Cheyne Stokes Breathing

CPAP therapy targeted to normalize the apnea hypopnea index (AHI) is indicated for the initial treatment of CSAS related to CHF. (STANDARD)
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BPAP therapy in a spontaneous timed (ST) mode targeted to normalize the apnea hypopnea index (AHI) may be considered for the treatment of CSAS related to CHF only if there is no response to adequate trials of CPAP, ASV, and oxygen therapies. (OPTION)
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Adaptive Servo-Ventilation (ASV) targeted to normalize the apnea-hypopnea index (AHI) is indicated for the treatment of CSAS related to CHF. (STANDARD)
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Nocturnal oxygen therapy is indicated for the treatment of CSAS related to CHF. (STANDARD)
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The following therapies have limited supporting evidence but may be considered for the treatment of CSAS related to CHF, after optimization of standard medical therapy, if PAP therapy is not tolerated, and if accompanied by close clinical follow-up: acetazolamide and theophylline. (OPTION)
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The following possible treatment options for CSAS related to end stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (OPTION)
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Recommendation Grading

Overview

Title

Treatment of Central Sleep Apnea Syndromes in Adults

Authoring Organization

Publication Month/Year

May 1, 2016

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this practice parameter is to review the available data for the treatment and management of CSAS in adults. When possible, a relative determination was made as to the most effective treatment option.

Target Patient Population

Patients with central sleep apnea syndrome

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D012891 - Sleep Apnea Syndromes, D020182 - Sleep Apnea, Central

Keywords

sleep apnea, central sleep apnea

Source Citation

J Clin Sleep Med 2016;12(5):757-761.