Clinical Features And Diagnosis

The presenting symptoms for patients with hypercapnic CSA may include symptoms of the underlying disease and features of sleep apnea. These symptoms include daytime sleepiness, snoring, and poor nocturnal sleep, as well as morning headache, peripheral edema, and dyspnea.

Patients with nonhypercapnic central apnea can present with symptoms similar to obstructive sleep apnea including snoring and excessive daytime sleepiness. Alternatively, patients with CSA may present with insomnia and poor nocturnal sleep.

FIGURE 3 A polysomnography segment showing central apnea in a patient with central apnea syndrome, electromyogram (EMG), electroencephalogram (EEG) leads are C3 (left central) and O1 (left occipital). Abbreviations: Flow, airflow; RIP, respiratory inductance plethysmograph, representing rib cage (RC) and abdominal (AB) effort signals, as well as a summed (SUM) signal; SAO2, oxygen saturation. Note absence of flow and effort (double arrow) indicative of central apnea.

FIGURE 3 A polysomnography segment showing central apnea in a patient with central apnea syndrome, electromyogram (EMG), electroencephalogram (EEG) leads are C3 (left central) and O1 (left occipital). Abbreviations: Flow, airflow; RIP, respiratory inductance plethysmograph, representing rib cage (RC) and abdominal (AB) effort signals, as well as a summed (SUM) signal; SAO2, oxygen saturation. Note absence of flow and effort (double arrow) indicative of central apnea.

This may be due to frequent oscillation between wakefulness and stage 1 NREM sleep. Unfortunately, studies on the clinical features of patients with CSA are limited.

The diagnosis of CSA requires nocturnal polysomnography. Figure 3 shows a polygraphic example of a central apnea demonstrating absence of flow and effort.

Sleep Apnea

Sleep Apnea

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