Conclusions

The heterogeneity of CSA mandates an individualized management approach. For example, treatment options for CSA associated with CHF begin with ensuring optimal CHF treatment with diuretics, beta-blockers, and reduction of afterload. Supplemental O2 and nasal CPAP therapy are both valid options. Supplemental O2 may be attempted during polysomnography in patients with significant hypoxia (oxyhemoglobin desaturation below 90%) following central events. For patients with idiopathic CSA, a trial of nasal CPAP or bilevel positive airway pressure is warranted, as many patients may respond to positive pressure therapy. However, nasal CPAP may aggravate central apnea in some patients. Finally, the development of effective, physiologically based pharmacological therapy for central apnea would be a major advance in the field.

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