Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- insomnia, especially sleep-maintenance insomnia
- poor concentration and attention span
- observed periodic breathing or cessation of breathing or snoring during sleep (by partner)
- transient dyspnoea that awakens from sleep or prevents sleep onset
- headaches upon waking
- complaints of poorly restorative sleep and/or daytime sleepiness
- periodic breathing during wakefulness
Other diagnostic factors
- abnormal heart rhythm or the presence of third or fourth heart sounds
- focal abnormality on neurological examination
- neuromuscular weakness
- history of endocrine disorders
Risk factors
- congestive heart failure
- stroke
- renal failure
- male sex
- atrial fibrillation
- age ≥60 years
- opioid use
- brainstem lesions
- neuromuscular weakness
- acromegaly
- hypothyroidism
Diagnostic investigations
Investigations to consider
- serum thyroid stimulating hormone
- serum creatinine
- ECG
- serum insulin-like growth factor 1 (acromegaly testing)
- echocardiogram
Treatment algorithm
Contributors
Authors
Bernardo J. Selim, MD
Associate Professor of Medicine
Director of Respiratory Care Unit
Division of Pulmonary, Critical Care, and Sleep Medicine
Mayo Clinic
Rochester
MN
Disclosures
BJS declares that he has no competing interests.
Lauren A. Tobias, MD
Assistant Professor of Medicine
Yale University School of Medicine
Department of Internal Medicine
Section of Pulmonary, Critical Care and Sleep Medicine
New Haven
CT
Disclosures
LAT declares that she has no competing interests.
Acknowledgements
Dr Bernardo J. Selim and Dr Lauren A. Tobias would like to gratefully acknowledge Dr J. Shirine Allam, Dr Timothy I. Morgenthaler, and Dr Christine H. Won, previous contributors to this topic.
Disclosures
JSA and TIM declare that they have no competing interests. CHW declares that she has been a speaker for Respironics CME.
Peer reviewers
Teofilo Lee-Chiong, MD
National Jewish Medical and Research Center
Denver
CO
Disclosures
TLC has been reimbursed by the American College of Chest Physicians (ACCP), American Academy of Sleep Medicine, American Thoracic Society, and Cephalon, the manufacturer of modafinil, for attending several conferences. He has been paid by the ACCP for running educational programs and by Elsevier for serving as consultant of the Sleep Medicine Clinics. He has also received research funding from the National Institutes of Health, Respironics, Restore, and Schwarz Pharma, and has been a member of the speakers' bureau for GlaxoSmithKline.
John A. Fleetham, MD, FRCP
Professor
University of British Columbia
Vancouver
Canada
Disclosures
JAF declares that he has no competing interests.
References
Key articles
American Academy of Sleep Medicine. The AASM international classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Full text
Randerath W, Verbraecken J, Andreas S, et al. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017 Jan;49(1):1600959.Full text Abstract
Mayer G, Arzt M, Braumann B, et al. German S3 guideline nonrestorative sleep/sleep disorders, chapter "sleep-related breathing disorders in adults," short version: German Sleep Society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, DGSM). Somnologie (Berl). 2017;21(4):290-301.Full text Abstract
Aurora RN, Bista SR, Casey KR, et al. Updated adaptive servo-ventilation recommendations for the 2012 AASM guideline: "The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses". J Clin Sleep Med. 2016 May 15;12(5):757-61.Full text Abstract
Aurora RN, Chowdhuri S, Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep. 2012 Jan 1;35(1):17-40.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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