Central sleep apnoea

Primary central sleep apnoea (CSA); all criteria should be met for diagnosis

Patient reports at least one of the following:
- Excessive daytime sleepiness
- Frequent arousals and awakenings during sleep or insomnia complaints
- Awakening short of breath
- Witnessed apnoeas
Polysomnography (PSG) shows ≥5 central apnoeas and/or central hypopnoeas per hour of sleep, representing >50% of total respiratory events in the apnoea-hypopnoea index. No Cheyne-Stokes breathing (CSB) should be noticed.
There is no evidence of daytime or nocturnal hypoventilation.
The disorder is not better explained by another current sleep disorder, a medical or neurological disorder, medication use, or a substance use disorder.

CSA with CSB; all criteria should be met for diagnosis

Patient reports at least one of the symptoms mentioned in primary CSA or the presence of atrial fibrillation/flutter, congestive heart failure, or a neurological disorder.
The polysomnographic definition is similar to primary CSA with a ventilatory pattern compatible with CSB, based on recurrent central apnoeas and/or central hypopnoeas separated by a crescendo and decrescendo change in breathing amplitude, with a cycle length of ≥40 seconds, and ≥5 central apnoeas or hypopnoeas per hour of sleep.
The disorder is not better explained by another current sleep disorder, medication use, or substance use disorder (e.g., opioids).

CSA due to medical disorder without CSB; all criteria must be met for diagnosis

Diagnostic criteria regarding presenting symptoms and polysomnography are the same as in primary CSA, but with the presence of a medical condition believed to cause the CSA without CSB.
Occurs as a consequence of a medical or neurological disorder of the brainstem (e.g., traumatic, vascular, demyelinating), but not due to medication use or substance misuse.

CSA due to high-altitude periodic breathing; all criteria should be met for diagnosis

Recent ascent to high altitude, typically at least 8000 feet (2500 metres), although CSA may present at lower altitude (4900 feet [around 1500 metres]) in certain individuals.
Patient reports at least one of the following:
- Excessive daytime sleepiness
- Frequent arousals and awakenings during sleep or insomnia complaints
- Awakening short of breath or morning headache
If polysomnography is performed, it demonstrates recurrent central apnoeas and/or hypopnoeas, at a frequency of ≥5 events per hour.
The disorder is not better explained by another current sleep disorder, medical or neurological disorder, medication use, or substance use disorder (e.g., opioids).
Recurrent awakening during the night and fatigue during the day may be present.

CSA due to a medication or substance misuse; all criteria should be met for diagnosis

The patient has been taking an opioid or other known respiratory depressant (e.g., ticagrelor).
Patient reports at least one of the symptoms mentioned in primary CSA.
Polysomnographic criteria are similar to those for primary CSA.
The disorder is not better explained by another current sleep disorder, or by a medical or neurological disorder.

Treatment-emergent CSA; all criteria should be met for diagnosis:

Diagnostic PSG shows ≥5 predominantly obstructive respiratory events (obstructive or mixed apnoeas, hypopnoeas, or respiratory event-related arousals) per hour of sleep.
PSG during use of positive airway pressure shows significant resolution of obstructive respiratory events (e.g., obstructive or mixed apnoeas or hypopnoeas) and emergence or persistence of central apnoeas with ≥5 events per hour, representing ≥50% of total apnoea-hypopnoea index.
Patient reports at least one of the symptoms mentioned in primary CSA.
The disorder is not better explained by another CSA disorder.

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Criteria