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In polysomnography, an oronasal thermal airflow sensor and respiratory inductance plethysmography (RIP) belts at thorax and abdomen are used to detect central sleep apnoea. These sensors are uncomfortable to wear, can disturb the patient’s sleep, and data quality can be significantly di-minished if a sensor slips off the patient. Contactless meas-urements would be a desirable alternative. We utilized a 3D time-of-flight sensor to monitor respiratory-related chest movements to decipher epochs of normal breathing and ap-noea in ten adult patients with a total of 467 apnoea events. Time-synchronized comparisons of 3D measurements of chest movements due to respiration to polysomnography signals from rip belts and nasal airflow proved that the 3D sensor provided largely equivalent results. This new tech-nique could support the diagnosis of central sleep apnoea and Cheyne-Stokes respiration.

The prevalence, prognosis, clinical presentation, pathophysiology, diagnosis, and treatment of the central sleep apnoea syndrome (CSAS) are reviewed and its relationship with congestive heart failure (CHF) is discussed. Adequately powered trials are needed with survival and health status as end points to establish whether correction of sleep related breathing abnormalities improves the outcome in patients with CHF.

Chronic heart failure is a clinical syndrome with a high mortality and morbidity. Despite optimal therapy, five-year survival is still only 50%. Central sleep apnoea syndrome is seen in approximately 40% of patients with congestive heart failure. Sleep apnoea syndrome can be divided into two forms in these patients: obstructive sleep apnoea syndrome (OSAS) and central sleep apnoea syndrome (CSAS, Cheyne-Stokes respiration), of which CSAS is the most common. CSAS is a form of sleep apnoea in congestive heart failure which is driven by changes in pCO(2). As a consequence of apnoea-hypopnoea an imbalance in myocardial oxygen delivery/consumption ratio will develop, sympathetic and other neurohormonal systems will be activated and right and left ventricular afterload will be increased. Sleep apnoea is associated with an increased mortality in patients with systolic heart failure. Treatment of sleep apnoea increases left ventricular ejection fraction and transplant-free survival. Because of its high prevalence, poor quality of life, poor outcome, and the beneficial effects of treatment, physicians treating patients with heart failure should be aware of central sleep apnoea. There are different treatment options, but the exact effects and indications of each option have not yet been fully determined. Further studies should be done to further investigate its prevalence, and to establish the most adequate therapy for the individual patient. (Neth Heart J 2010;18:260-3.).

We report the case of a 47-year-old man with idiopathic central sleep apnoeas recurring during wake-sleep transitions at night or at diurnal naps. Symptoms associated with central apnoeas were sudden awakening with shortness of breath, sleep fragmentation and daytime tiredness. Following the failure of CPAP and BiPAP, we treated the patient with zolpidem which reduced central apnoea events, improved sleep and eliminated the patient's nocturnal disturbing symptoms. Beneficial effects were still present after two years of treatment. Our case demonstrates that zolpidem may be beneficial in the long term treatment of idiopathic central sleep apnoea syndrome.

During recent years, it has become evident that disturbed sleep, whether central sleep apnoea syndrome or obstructive sleep-disordered breathing (SDB), may lead to several other effects, such as cardiovascular diseases and many metabolic disturbances. Although the treatment of these sleeping problems is based on ventilatory support and pharmacological agents (in the case of central sleep apnoea or hypoventilation), positive airway pressure systems or upper airway surgery/oral appliances (in the case of obstructive SDB), the treatment effects are not always clear. The treatment effects, in particular on metabolic disturbances, need more investigation, whereas some effects, for instance, on cardiovascular outcome parameters, already seem quite convincing. Related ethical dilemmas may also arise, such as “sleep apnoea and driving”, where it is not always easy to find the optimal solution. The purpose of the international symposium “Respiratory …

SummaryThe preliminary results of the SERVE-HF study have led to the release of safety information with subsequent contraindication to the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnoeas in patients with chronic symptomatic systolic heart failure with left ventricular ejection fraction (LVEF) ≤ 45%. The aim of this article is to review these results, and to provide more detailed arguments based on data from the literature advocating the continued use of ASV in different indications, including heart failure with preserved LVEF, complex sleep apnoea syndrome, opioid-induced central sleep apnea syndrome, idiopathic central SAS, and central SAS due to a stroke. Based on these findings, we propose to set up registers dedicated to patients in whom ASV has been stopped and in the context of the next setting up of ASV in these specific indications to ensure patient safety and allow reasoned decisions on the use of ASV.