Central Sleep Apnea and Hypoventilation Syndrome

Central sleep apnea hypopnea syndrome (CSAHS) and sleep hypoventilation syndrome (SHVS) are two distinct clinical syndromes with clearly defined diagnostic criteria. It is important to distinguish between normo/hypocapnic and hypercapnic CSAHS prior to treatment. Nasal continuous positive airway pressure is currently considered the primary treatment of choice for normo/hypocapnic CSAHS. The initial management of hypercapnic CSAHS and SHVS should include identification of any treatable causes and discontinuation of any sedative medications. Medroxyprogesterone may be effective in the long term management of these patients. If pharmacologic therapy fails, assisted ventilation should be considered. Assisted ventilation during the night is usually sufficient to improve hypercapnia and hypoxemia both at night and during the day. Assisted ventilation is usually best administered through a tight fitting nasal mask.