New discovery provides treatment for central sleep apnea

Volume 13    |   Issue 132

Did you know that there are two different kinds of sleep apnea? There are several different ways to treat one kind. But the other kind doesn't have any effective way to treat it — until now!

The most common form by far is called obstructive sleep apnea or OSA. OSA happens when the airway relaxes, closes down, and prevents the patient from being able to breathe normally. This is almost always associated with snoring. And it can be treated in various ways including surgery, dental appliances, and a breathing device called C-Pap.

The other kind of apnea is called central sleep apnea or CSA. CSA happens when during sleep the brain fails to send signals to the diaphragm telling it to start a breath. The result is that the patient simply stops making any effort to breathe. CSA occurs in the absence of obstruction of the airway. There is no snoring.

According to Dr. William Abraham, director of the Division of Cardiovascular Medicine at The Ohio State University Wexner Medical Center, "CSA is a serious concern because it affects about a third of people with heart failure and it's known to make the condition worse. Currently, we don't have good treatments available. Positive airway pressure devices [C-pap] have been used, but many patients don't tolerate them well and a recent study showed them to be harmful." Dr. Abraham is the co-lead author of the recent study showing that an implanted nerve stimulator significantly improves symptoms in those with CSA, without causing any serious side effects.

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The nerve stimulator acts a lot like a pacemaker. It sends out regular signals telling the diaphragm to continuously breathe during sleep. In the study Dr. Abraham implanted the device into 151 men and women with CSA. During the first six months of evaluation, 68 devices were activated for treatment, while 73 were left inactive as the control group. Here's what happened. Of those devices that were not turned on, 11% of the patients had a greater than 50% reduction in apnea episodes. Compare that to 51% of the patients in which the devices were working saw a reduction in episodes. That's close to a 500% improvement from the devices compared to standard therapy. And that's not all.

Other important sleep measures, such as the amount of time spent with a low blood oxygen level, were also significantly improved. And in Dr. Abraham's words, "Not only did we see this reduction in events per hour, the patients also rated themselves better on the Epworth Sleepiness Scale [meaning they were less sleepy during the day] and on a global assessment of their overall quality of life. This tells us the effects of neurostimulation are clinically relevant and this could be a promising therapy for those with central sleep apnea."

Unfortunately, in most people with CSA the cause is unknown, which is why the treatments are so unsuccessful. But there is one cause of CSA that can be treated effectively. And that is the effect of certain substances that tend to depress the signals from the brain to the diaphragm. The list includes alcohol, sedatives, or other drugs such as pain medications. So if you are taking any of these drugs and have been diagnosed with CSA, make sure you stop them just to see if they are the cause.

Yours for better health,





Abraham WT. Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. The Lancet, September 2016

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