According to the US National Heart, Lung, and Blood Institute (NHLBI), obstructive sleep apnoea is caused by conditions that block airflow through the upper airway during sleep. A review in The Lancet (2014) describes repeated upper airway collapse with oxygen desaturation and disrupted sleep. Features can include, for example, snoring, witnessed apnoeas and sleepiness. Risk factors include, for example, obesity, male sex, age, menopause and smoking. According to this review, continuous positive airway pressure (CPAP) is the treatment of choice.
According to the NHLBI, central sleep apnoea is caused by problems with the way the brain controls breathing during sleep. The risk can be raised, for example, by heart failure, stroke, ALS, myasthenia gravis, opioid use disorder or long-term use of opioid pain medicines. According to a review in the Handbook of Clinical Neurology (2022), nocturnal polysomnography is the standard diagnostic method. The distinction matters for treatment: in the SERVE-HF trial in the New England Journal of Medicine (2015), with 1,325 patients with heart failure with reduced ejection fraction (45 % or less) and predominantly central sleep apnoea, all-cause and cardiovascular mortality were higher under adaptive servo-ventilation, a special form of breathing support during sleep, than in the control group.
The American Academy of Sleep Medicine guideline (2017) recommends polysomnography or a technically adequate home sleep apnoea test for uncomplicated adults at increased risk of moderate to severe obstructive sleep apnoea. If a home test is negative or inconclusive, polysomnography should follow. For patients with, for example, significant cardiorespiratory disease, neuromuscular conditions, chronic opioid use, a history of stroke or severe insomnia, it recommends polysomnography in a sleep laboratory as the first choice. For home tests using peripheral arterial tonometry (for example WatchPAT), a meta-analysis in JAMA Otolaryngology (2013) found a high correlation of the measurements with polysomnography (r = 0.89). The authors consider the method a viable alternative. A meta-analysis in the Journal of Sleep Research (2022), by contrast, does not consider these home tests an equivalent replacement. In a validation study with manufacturer involvement in Sleep and Breathing (2020) with 84 patients, WatchPAT detected central sleep apnoea at an AHI of 15 or more with a sensitivity of 67 % and a specificity of 100 %.
This question belongs to the topic Conditions alongside burnout. It lists further questions.
What can be raised at a medical check-up about obstructive and central sleep apnoea, meaning blocked airways or a breathing control problem?
- snoring and breathing pauses observed by someone else
- heart disease, stroke or neuromuscular conditions
- use of opioid medicines
- whether a home test or a sleep laboratory is suitable
Exhaustion can have many causes, including illnesses that need treatment. For this reason a medical assessment comes before coaching, usually starting at the GP practice.
When can exhaustion become an emergency? · Why see a doctor before coaching for burnout?
Which prompt can be given to an AI assistant about obstructive and central sleep apnoea, meaning blocked airways or a breathing control problem?
At the start of your answer, point out that this topic needs medical review and that your information may contain errors. First ask me which city I am searching in. List sleep laboratories or sleep medicine practices in my city that distinguish between obstructive and central sleep apnoea and offer home tests or polysomnography. Give the source for every piece of information and mark what is uncertain. Do not make a diagnosis and do not recommend any treatment. Separately, tell me which details I should check directly with the practice.
With some services, the prompt needs to be pasted after signing in. The AI services belong to third parties. Depending on the service and the extent of use, signing in and costs may apply. AI answers can contain errors.
Which sources support the answer on obstructive and central sleep apnoea, meaning blocked airways or a breathing control problem?
- Jordan AS, McSharry DG, Malhotra A (2014): Adult obstructive sleep apnoea. The Lancet 383, 736–747
- Cowie MR et al. (2015): Adaptive servo-ventilation for central sleep apnea in systolic heart failure (SERVE-HF). New England Journal of Medicine 373, 1095–1105
- Ginter G, Badr MS (2022): Central sleep apnea. Handbook of Clinical Neurology 189, 93–103
- Yalamanchali S et al. (2013): Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis. JAMA Otolaryngology–Head & Neck Surgery 139(12), 1343–1350
- Ichikawa M et al. (2022): Diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea: a systematic review and meta-analysis. Journal of Sleep Research 31(6), e13682
- Pillar G et al. (2020): Detecting central sleep apnea in adult patients using WatchPAT – a multicenter validation study. Sleep and Breathing 24(1), 387–398
- Kapur VK et al. (2017): Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine 13(3), 479–504
- National Heart, Lung, and Blood Institute (NIH): Sleep apnea – causes and risk factors
- NHS: Sleep apnoea