Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep
Chairs: W. Randerath, J. Verbraecken & P. Levy
The complexity of sleep related breathing disorders has been realized more and more clearly in recent years. Patients present with relevant comorbidities to sleep physicians, especially heart failure, atrial fibrillation, arterial hypertension, stroke. We see developments in medical practice, including the increasing use of opioids for chronic pain, and realize epidemiologic changes, such as the increasing population of obese persons.
These patients often do not or not only show obstructive sleep apnoea (OSA) but also periodic breathing or central sleep apnoea (CSA). Different phenotypes of central disturbances are more precisely diagnosed. These include atactic breathing or hypoventilation syndromes. Highly prevalent diseases, such as COPD, may coincide with breathing disorders during sleep, leading to more complicated clinical entities. In addition a huge discussion evolved on the question of central apnoea evolving under CPAP (complex sleep apnoea).
There is a lack of knowledge on the pathophysiological background of these clinical features. Clear definitions of the disorders which allow for a precise discrimination and therapeutical algorithm are needed for scientific and clinical reasons. Several questions are open for discussion:
- Can we propose staging systems for these disorders?
- Can obesity hypoventilation, complex sleep apnoea, opioids related 4
- Sleep apnoea and hypoventilation syndromes be positively diagnosed or only if other possible causes are excluded?
- Do we need screening tests in population groups?
- Do we have to extent our diagnostical armentarium?