What Is the Difference between Central and Obstructive Sleep Apnea?

June 23, 2022
Sleep apnea is a disorder that affects many Americans, whether they know it or not. An estimated 20 percent of adults suffer from obstructive sleep apnea, though about 90 percent of cases are undiagnosed. Central sleep apnea is far less common, affecting only about 1 percent of adults.

Both kinds of sleep apnea can dramatically impact a person’s life. Losing sleep and not getting enough oxygen at night can not only make a person fatigued and irritable during the day but also put them at risk for serious health concerns. Read on to learn more about the differences between central and obstructive sleep apnea.

Central vs. Obstructive Sleep Apnea

Both central sleep apnea and obstructive sleep apnea are characterized by periodic pauses in breathing during sleep. However, breathing stops in different ways depending on the kind of sleep apnea a person has.

Obstructive sleep apnea involves a physical blockage of the airway that either partially or completely stops breathing despite a person’s efforts to breathe.9 It is often accompanied by snoring, with periods of quiet when breathing is interrupted.9

Central sleep apnea, on the other hand, does not involve a physical blockage of the airway.5 Instead, there are periods in which airflow stops because a person’s body does not attempt to breathe.

There is also a condition called mixed or complex sleep apnea, which occurs when central sleep apnea and obstructive sleep apnea occur simultaneously.

Causes

Both central and obstructive sleep apnea typically present as multifactorial diseases.1,9 For central sleep apnea, the cause is not a single etiology but rather a result of breathing instability due to a multitude of medical conditions. Central sleep apnea can be caused by chronic opioid use, high altitude, heart conditions, and other factors.1,5,7 Obstructive sleep apnea, on the other hand, can be caused by obesity, alcohol abuse, allergies, congestion, a narrow throat, and other factors that could cause the airway to become blocked.

Diagnosing Sleep Apnea

In order to determine if a person has any type of sleep apnea, a doctor may choose to conduct a sleep study, also known as a polysomnogram. Sleep studies can be done overnight in a sleep center lab or even at home.

During a sleep study, a patient will be hooked up to equipment that will record information electronically during sleep. Throughout the night, data may be recorded about muscle and brain activity, as well as breathing measurements. This data will show how often a person wakes during the night and whether or not there are pauses in breathing, brain activity, and body position.

Treating Sleep Apnea

There are several ways to treat sleep apnea. Some treatments can be used for both obstructive sleep apnea and central sleep apnea. Other treatments are specific to the type of sleep apnea and what may be causing it. These treatments include the following:

CPAP Machine (OSA and CSA)

A continuous positive airway pressure (CPAP) machine is a common treatment for obstructive sleep apnea, and it can be used for central sleep apnea as well. The machine delivers continuous air pressure into the airway to prevent it from closing.

BiPAP (OSA and CSA)

Similar to a CPAP machine, a bilevel positive airway pressure device delivers air at two different pressures as a person breathes in and out to keep the airway open. While this device can be used for obstructive sleep apnea and central sleep apnea, it can make central sleep apnea worse for a person who has heart failure.1

ASV (CSA)

Adaptive servo-ventilation (ASV) is an airway pressure treatment for central sleep apnea patients.1 This device delivers pressurized air, but it continuously adjusts the pressure level to adapt to a person’s breathing pattern.1 Like a BiPAP, this device can be problematic for patients with certain heart conditions. It is not recommended for people with heart failure.1

Supplemental Oxygen (CSA)

For some central sleep apnea patients, using supplemental oxygen at night can be helpful.1 A variety of devices can deliver extra oxygen to help a person get enough oxygen into their blood and sleep better.

Oral Appliances (OSA)

A dentist can fit different oral appliances for patients with milder obstructive sleep apnea cases or those who cannot tolerate airway pressure devices. These devices can help enlarge the airway and prevent it from collapsing during sleep. Some appliances may move the tongue forward, while others focus on changing the jaw position to improve breathing.

Weight Loss (OSA)

Losing weight can be beneficial for patients with obstructive sleep apnea.9 In obese patients with obstructive sleep apnea, a buildup of fatty tissue can narrow the airway and cause increased pressure and obstruction of breathing. Obese patients who lose weight can experience an improvement in obstructive sleep apnea symptoms.9

Reducing Opioid Use (CSA)

Chronic opioid use is associated with central sleep apnea and other sleep-disordered breathing. Some studies have found that about 24 percent of chronic opioid users had central sleep apnea. Higher doses of opioids were also associated with more severe cases of central sleep apnea.3 Reducing opioid consumption can help improve central sleep apnea symptoms.3

Medications (CSA)

There are some medications that can improve breathing during sleep for people with central sleep apnea.1,5 A doctor can prescribe drugs that stimulate breathing for CSA patients.5 Acetazolamide (diuretic) has been shown in several studies to decrease the severity of central apnea when administered before bedtime.1

Addressing Underlying Health Conditions (OSA and CSA)

Central and obstructive sleep apnea can be caused by underlying health conditions.7 Typically, multiple factors contribute to a patient’s sleep apnea.1,7 Obesity, heart failure, stroke, atrial fibrillation, and other factors can contribute to both obstructive and central sleep apnea.6,7,9 Treating these conditions may improve sleep apnea symptoms.4,7

Surgery (OSA and CSA)

When other treatments are not effective or are difficult for patients to tolerate, surgery may be an option. Different surgeries can be beneficial for both obstructive and central sleep apnea. In central sleep apnea patients, a pulse generator can be implanted in the upper chest that delivers an electrical pulse to the phrenic nerve. This nerve controls the diaphragm, and the pulse can stimulate breathing during sleep. For patients with obstructive sleep apnea, surgery may be considered to reduce the obstruction of the airway.2 This may involve removing tissue in the nose, throat, or palate.2 A device can also be implanted that stimulates a nerve that controls the tongue and moves it out of the airway.

Central and obstructive sleep apnea can interrupt sleep and put people at risk for serious health problems. Getting an accurate diagnosis and proper treatment can alleviate symptoms for people with sleep apnea.

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References

  1. Badr, M. S., Dingell, J. D., & Javaheri, S. (2019). Central Sleep Apnea: a Brief Review. Current pulmonology reports, 8(1), 14–21. https://doi.org/10.1007/s13665-019-0221-z
  2. Caples, S. M., Rowley, J. A., Prinsell, J. R., Pallanch, J. F., Elamin, M. B., Katz, S. G., & Harwick, J. D. (2010). Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep, 33(10), 1396–1407. https://doi.org/10.1093/sleep/33.10.1396
  3. Correa, D., Farney, R. J., Chung, F., Prasad, A., Lam, D., & Wong, J. (2015). Chronic opioid use and central sleep apnea: a review of the prevalence, mechanisms, and perioperative considerations. Anesthesia and analgesia, 120(6), 1273–1285. https://doi.org/10.1213/ANE.0000000000000672
  4. Donovan, L. M., & Kapur, V. K. (2016). Prevalence and Characteristics of Central Compared to Obstructive Sleep Apnea: Analyses from the Sleep Heart Health Study Cohort. Sleep, 39(7), 1353–1359. https://doi.org/10.5665/sleep.5962
  5. Eckert, D. J., Jordan, A. S., Merchia, P., & Malhotra, A. (2007). Central sleep apnea: Pathophysiology and treatment. Chest, 131(2), 595–607. https://doi.org/10.1378/chest.06.2287
  6. Jehan, S., Zizi, F., Pandi-Perumal, S. R., Wall, S., Auguste, E., Myers, A. K., & McFarlane, S. I. (2017). Obstructive sleep apnea and obesity: Implications for public health. Sleep Medicine and Disorders : International Journal, 1(4). doi:10.15406/smdij.2017.01.00019
  7. Mehra R. (2019). Sleep apnea and the heart. Cleveland Clinic journal of medicine, 86(9 Suppl 1), 10–18. https://doi.org/10.3949/ccjm.86.s1.03
  8. Muza R. T. (2015). Central sleep apnoea-a clinical review. Journal of thoracic disease, 7(5), 930–937. https://doi.org/10.3978/j.issn.2072-1439.2015.04.45
  9. Strohl, K. P. (2019). MSD Manual Professional Version: Obstructive Sleep Apnea. Retrieved May 25, 2022, from https://www.msdmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea