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Types of sleep disordered breathing (SDB)

There are three main types of sleep-disordered breathing which are manifested in sleep apnea. Discovering the specific differences between them can help you recognise how best to treat your patients.

  1. Obstructive sleep apnea (OSA)
  2. Central sleep apnea (CSA)
  3. Complex sleep apnea

OSA

OSA is a common disorder characterised by repetitive upper airway collapse during sleep resulting in apneas (cessation of airflow) and hypopneas (reduced airflow)1.

The primary indications of upper airway obstruction are:

  • lack of muscle tone during sleep
  • excess tissue in the upper airway
  • the structure of the upper airway and jaw

OSA determined by polysomnography is highly prevalent, affecting 25% of men and 10% of women in the United States although most are asymptomatic.2

Central sleep apnea (CSA)

CSA is clinically defined by a lack of drive to breathe during sleep, resulting in repetitive periods of insufficient ventilation leading to compromised gas exchange, in contrast to OSA where there is an ongoing respiratory effort.3 These nocturnal breathing disturbances can lead to various comorbidities and can increase the risk of cardiovascular events.3 There are several known variations of CSA, including high altitude-induced periodic breathing, idiopathic CSA, narcotic-induced CSA, and Cheyne-Stokes respiration (CSR). While unstable ventilatory control during sleep is an indication of CSA, the pathophysiology and the prevalence of the various forms can vary greatly.

Patients with CSA don't often snore, so the condition sometimes goes unnoticed.

Complex sleep apnea

Complex sleep apnea (CompSA) can be clinically defined as a combination of obstructive sleep apnea with central sleep apnea or Cheyne-Stokes breathing pattern.4 Patients who have CompSA present with both a reduced upper airway tone, resulting in an obstruction during sleep, and unstable ventilatory control, resulting in a cessation of respiratory effort leading to a central apnea.4

References

1

Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research. The Report of an American Academy of Sleep Medicine Task Force SLEEP, Vol. 22, No. 5, 1999

2

Peppard et al. Increased Prevalence of Sleep-Disordered Breathing in Adults. Am J Epidemiol. 2013

3

Eckert. Central Sleep Apnea pathophysiology and treatment. Chest. 2007

4

Morgenthaler T. Complex sleep apnea syndrome: is it a unique clinical syndrome? Sleep Vol 29 No 9 2006 http://www.journalsleep.org/Articles/290911.pdf