Central sleep apnea

Primary central sleep apnea (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 apneas
Polysomnography (PSG) shows ≥5 central apneas and/or central hypopneas per hour of sleep, representing >50% of total respiratory events in the apnea-hypopnea 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 neurologic 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 neurologic disorder.
The polysomnographic definition is similar to primary CSA with a ventilatory pattern compatible with CSB, based on recurrent central apneas and/or central hypopneas separated by a crescendo and decrescendo change in breathing amplitude, with a cycle length of ≥40 seconds, and ≥5 central apneas or hypopneas 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 neurologic 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 2500 meters (8000 feet), although CSA may present at lower altitude (around 1500 meters [4900 feet]) 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 apneas and/or hypopneas, at a frequency of ≥5 events per hour.
The disorder is not better explained by another current sleep disorder, medical or neurologic 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 neurologic disorder.

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

Diagnostic PSG shows ≥5 predominantly obstructive respiratory events (obstructive or mixed apneas, hypopneas, 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 apneas or hypopneas) and emergence or persistence of central apneas with ≥5 events per hour, representing ≥50% of total apnea-hypopnea 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