中枢性睡眠呼吸暂停
周期性呼吸
医学
呼吸过度
呼吸暂停
清醒
低碳酸血症
麻醉
呼吸控制
睡眠呼吸暂停
心脏病学
神经科学
内科学
多导睡眠图
呼吸系统
心理学
高碳酸血症
脑电图
酸中毒
精神科
作者
Shahrokh Javaheri,M. Safwan Badr
出处
期刊:Sleep
[Oxford University Press]
日期:2022-05-11
被引量:2
标识
DOI:10.1093/sleep/zsac113
摘要
Abstract Central sleep apnea is not a single disorder; it can present as an isolated disorder or as a part of other clinical syndromes. In some conditions, such as heart failure, central apneic events are due to transient inhibition of ventilatory motor output during sleep, owing to the overlapping influences of sleep and hypocapnia. Specifically, the sleep state is associated with removal of wakefulness drive to breathe; thus, rendering ventilatory motor output dependent on the metabolic ventilatory control system, principally PaCO2. Accordingly, central apnea occurs when PaCO2 is reduced below the “apneic threshold”. Our understanding of the pathophysiology of central sleep apnea has evolved appreciably over the past decade; accordingly, in disorders such as heart failure, central apnea is viewed as a form of breathing instability, manifesting as recurrent cycles of apnea/hypopnea, alternating with hyperpnea. In other words, ventilatory control operates as a negative—feedback closed-loop system to maintain homeostasis of blood gas tensions within a relatively narrow physiologic range, principally PaCO2. Therefore, many authors have adopted the engineering concept of “loop gain” (LG) as a measure of ventilatory instability and susceptibility to central apnea. Increased LG promotes breathing instabilities in a number of medical disorders. In some other conditions, such as with use of opioids, central apnea occurs due to inhibition of rhythm generation within the brainstem. This review will address the pathogenesis, pathophysiologic classification, and the multitude of clinical conditions that are associated with central apnea, and highlight areas of uncertainty.
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