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Central Sleep Apnea Where Are We Now BADR
Central Sleep Apnea Where Are We Now BADR
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Pdf Summary
The document provides an overview of issues related to central apnea, focusing on potential underlying mechanisms, risk factors, and management strategies. Central apnea occurs due to a failure in respiratory drive and is often identified in specific populations with conditions like heart failure, opiate use, or high altitude exposure. Mechanisms such as impaired arousal response, low loop gain, hypocapnia, or high controller gain are explored as possible triggers for recurrent central apnea.<br /><br />The document outlines lesson objectives for understanding the etiology of central apnea, its differentiation from obstructive apnea, and management strategies. Central sleep apnea can be classified into types, including those with Cheyne-Stokes breathing, related to medical disorders, high altitude, or medications.<br /><br />Case studies and polysomnographic findings are presented to illustrate the clinical manifestations and impact of central apnea in different patient profiles, like those with heart failure or those under methadone maintenance. The document examines various treatment approaches, including Continuous Positive Airway Pressure (CPAP), Bilevel Positive Airway Pressure (BPAP), and Adaptive Servo-Ventilation (ASV). It highlights that treatment-emergent central apneas (TECSA) develop during CPAP therapy but often resolve over time. <br /><br />Research findings indicate that while CPAP benefits certain patients, it might not significantly impact survival in heart failure cases. ASV, although effective in central and obstructive apnea reduction, might not enhance mortality outcomes but improves patient quality of life and heart failure symptoms.<br /><br />In summary, central apnea management involves targeting underlying causes, optimizing ventilatory support, and possibly using pharmacological treatments. Adapting treatment to individual patient conditions and responses is crucial, given the variability in efficacy and potential risks, particularly in heart failure patients.
Keywords
central apnea
respiratory drive
risk factors
management strategies
Cheyne-Stokes breathing
polysomnographic findings
Continuous Positive Airway Pressure
Adaptive Servo-Ventilation
heart failure
treatment-emergent central apneas
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American College of Chest Physicians
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