Idiopathic central sleep apnoea an Indian case with polysomnographic findings.

Patients with idiopathic central sleep apnoea (ICSA) usually complain of poor quality sleep; yet many of them do not receive appropriate treatment because of poor recognition of ICSA by health professionals. We report the case of a patient with ICSA who was misdiagnosed and received treatment for seizures, depression or anxiety for a number of years and discuss the differential diagnosis and treatment options for ICSA.

Diagnosis of sleep apnoea: some critical issues.

Rather than describing a method for determining which patients should be labelled as having a disease, sleep apnoea, this review describes assessment as a process for deciding whom to investigate, what degree of sleep apnoea they have, how important their symptoms are, whether symptoms are likely attributable to sleep apnoea, and what sort of treatment to offer, if any. Beginning with identifying patients at risk and use of clinical prediction rules, the review covers (i) measurement and implications of the apnoeahypopnoea index; (ii) distinguishing central from obstructive apnoeas; (iii) significance of associated periodic limb movements; (iv) the controversy about the use of portable monitors instead of laboratory polysomnography; (v) evaluation of symptoms associated with sleep apnoea; and (vi) the important role of trials of treatment.

Central sleep apnoea.

Central sleep apnoea (CSA) is characterized by the cessation of breathing during sleep due to absent ventilatory drive and may be associated with symptoms of insomnia, excessive daytime sleepiness or frequent arousals. Central apnoeas occur through two pathophysiologic patterns, either posthyperventilation or post-hypoventilation. The prevalence of CSA is dependent on the population being studied, the predominant risk factors being elderly age group and co-morbid conditions. Data regarding the racial distribution of this disorder are very limited. CSA may be a clinical marker of underlying medical disorders, including cardiac or neurological disease, with resultant significant morbidity and mortality. Given that the underlying pathogenesis remains poorly understood, therapeutic options are currently limited to empiric treatment with PAP devices and rudimentary attempts at pharmacologic therapy with respiratory stimulant drugs and/or oxygen/carbon dioxide gas supplementation as well as treating the underlying cause. The long-term impact of CSA on health and mortality needs further clarification. Future research should be aimed at elucidating the physiologic determinants and consequences of central breathing instability in populations of different age groups, gender and racial descent, as a prerequisite to the development of novel therapeutic interventions in the different populations.