Medication-induced central sleep apnea: a unifying concept.

Area of Science:

• Sleep Medicine
• Pharmacology
• Neurology

Background:

• Medication-induced central sleep apnea (CSA) is a significant but often overlooked cause of sleep-disordered breathing.
• Opioids are known to cause CSA, but awareness of non-opioid medications inducing CSA is limited.
• Misclassification of medication-induced CSA as primary CSA can delay appropriate management.

Purpose of the Study:

• To highlight non-opioid medications that can cause central sleep apnea.
• To elucidate the mechanisms by which these drugs induce CSA.
• To emphasize the importance of identifying and discontinuing offending agents.

Main Methods:

• Review of existing literature on medication-induced central sleep apnea.
• Analysis of pharmacological mechanisms involving neurotransmitter systems (opioid, GABA).
• Description of breathing patterns observed during polysomnography.

Main Results:

• Non-opioid medications including sodium oxybate, baclofen, valproic acid, gabapentin, and ticagrelor are identified as causes of CSA.
• Opioids and certain non-opioid drugs (acting on GABA receptors) induce ataxic breathing patterns.
• Ticagrelor increases central chemosensitivity, leading to periodic breathing and CSA.

Conclusions:

• Accurate diagnosis of medication-induced CSA requires careful patient history and awareness of drug side effects.
• Discontinuation of the causative medication is an effective treatment for resolving CSA.
• Recognizing these adverse drug reactions is critical due to potential mortality risks associated with CSA.