Central sleep apnoea: not just one phenotype.

Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have prompted investigations aiming to achieve a more precise differentiation and description of the entities of central sleep apnoea (CSA). There is increasing evidence for the heterogeneity of CSA in terms of underlying aetiology, pathophysiological concepts, treatment response and outcome. Assigning patients to these phenotypes allows for the selection of individualised therapies. Major pathophysiological characteristics include loop gain, apnoeic threshold, breathing regulation and neuromuscular mechanics. Chronic heart failure is the most important underlying disease, leading to nonhypercapnic CSA based on increased loop and controller gain. Although many questions remain, this review tries to describe the current knowledge on the pathophysiology of the clinical entities. The description of prognostic aspects may guide treatment indication and the selection of pharmacotherapy and invasive options. In addition, the paper provides an update on the current understanding of adaptive servo-ventilation and its role in the treatment of CSA.
Competing Interests: Conflict of interest: W. Randerath reports lecture honoraria from Heinen & Löwenstein, Jazz Pharmaceuticals, Philips Respironics, Bioprojet, Westfalen Medical, and Habel Medizintechnik; travel support from Heinen & Löwenstein, Jazz Pharmaceuticals, Philips Respironics, and Bioprojet; advisory board participation with Bioprojet, Jazz Pharmaceuticals, Procter & Gamble, and Desitin; leadership roles as European Respiratory Society Head of Assembly 4 (Sleep Disordered Breathing) and German Respiratory Society Secretary General, outside the submitted work. S. Baillieul reports grants from the European Respiratory Society through a Long-Term Research Fellowship; lecture honoraria from Bioprojet, Vitalaire, and Jazz Pharmaceuticals SA; travel support from Bioprojet, Vitalaire, and Agir A Dom, outside the submitted work. R. Tamisier reports grants from Resmed, Inspire, and Bioprojet; consulting fees from Bioprojet, Resmed and Idorsia; lecture honoraria from Resmed, Philips, Bioprojet, Peerimetres, and Jazz Pharmaceuticals; and travel support from Agiradom, outside the submitted work.
(Copyright ©The authors 2024.)