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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
[Management of central sleep apnea]
I Boutin1, C Saint-Raymond, J-C Borel
1Laboratoire du sommeil et EFCR, pôle rééducation et physiologie , CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
Revue De Pneumologie Clinique
|October 1, 2009
Summary
Central sleep apnea, common in heart failure and neurological conditions, has two types: hypocapnic and hypercapnic. Treatment involves tailored ventilatory support based on patient assessment.
Area of Science:
- Sleep Medicine
- Respiratory Physiology
- Neurology
Context:
- Central sleep apnea (CSA) is frequently observed in patients with heart failure, neurological diseases, and those using chronic opioids.
- CSA presents with two primary classifications linked to distinct pathophysiological mechanisms.
- Understanding these classifications is crucial for accurate diagnosis and effective management.
Purpose:
- To differentiate the two main categories of central sleep apnea based on underlying conditions and respiratory control.
- To outline the essential diagnostic assessments, including blood gases, polysomnography, and specific cardiologic and neurologic evaluations.
- To describe the appropriate ventilatory support strategies for each type of CSA.
Summary:
- Hypocapnic CSA involves respiratory control system instability where PaCO(2) drops below the apnea threshold during sleep.
- Hypercapnic CSA is typically associated with chronic conditions like neuromuscular disorders or obesity hypoventilation syndrome.
- Diagnostic workup includes blood gases, polysomnography, CO(2) ventilatory response testing, pro-brain natriuretic factor (pro-BNP), cardiac echography, and neurological examinations (brain imaging/electromyography).
Impact:
- Provides a clear framework for diagnosing and classifying central sleep apnea.
- Highlights the importance of targeted diagnostic testing for effective treatment.
- Guides the selection of appropriate ventilatory support (non-invasive or servo-assisted) for hypocapnic and hypercapnic CSA patients, respectively.
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