Therapy for sleep hypoventilation and central apnea syndromes

Bernardo J. Selim, Mithri R. Junna, Timothy I. Morgenthaler

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


• Primary Central Sleep Apnea (CSA): We would recommend a trial of Positive Airway Pressure (PAP), acetazolamide, or zolpidem based on thorough consideration of risks and benefits and incorporation of patient preferences. • Central Sleep Apnea Due to Cheyne-Stokes Breathing Pattern in Congestive Heart Failure (CSR-CHF): We would recommend PAP devices such as continuous positive airway pressure (CPAP) or adaptive servo-ventilation (ASV) to normalize sleep-disordered breathing after optimizing treatment of heart failure. Oxygen may also be an effective therapy. Acetazolamide and theophylline may be considered if PAP or oxygen is not effective. • Central Sleep Apnea due to High-Altitude Periodic Breathing: We would recommend descent from altitude or supplemental oxygen. Acetazolamide may be used when descent or oxygen are not feasible, or in preparation for ascent to high altitude. Slow ascent may be preventative. • Central Sleep Apnea due to Drug or Substance: If discontinuation or reduction of opiate dose is not feasible or effective, we would recommend a trial of CPAP, and if not successful, treatment with ASV. If ASV is ineffective or if nocturnal hypercapnia develops, bilevel positive airway pressure-spontaneous timed mode (BPAP-ST) is recommended. • Obesity hypoventilation syndrome: We would recommend an initial CPAP trial. If hypoxia or hypercapnia persists on CPAP, BPAP, BPAP-ST or average volume assured pressure support (AVAPSTM) is recommended. Tracheostomy with nocturnal ventilation should be considered when the above measures are not effective. Weight loss may be curative. • Neuromuscular or chest wall disease: We would recommend early implementation of BPAP-ST based on thorough consideration of risks and benefits and patient preferences. AVAPSTM may also be considered. We recommend close follow up due to disease progression.

Original languageEnglish (US)
Pages (from-to)427-437
Number of pages11
JournalCurrent Treatment Options in Neurology
Issue number5
StatePublished - Oct 2012


  • Alveolar hypoventilation syndromes
  • Central apnea syndromes
  • Cheyne-Stokes breathing pattern
  • Drugs
  • High-altitude periodic breathing
  • Narcotics
  • Sleep hypoventilation
  • Sleep-related hypoventilation syndromes
  • Therapy

ASJC Scopus subject areas

  • Clinical Neurology


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