interestingly, a small study indicates that exercise training lessens the severity of obstructive sleep apnea but does not affect central sleep apnea in patients with heart failure and sleep disordered breathing. in addition to reinforcing the spontaneous breaths, patients with central sleep apnea may require additional breaths set as a back-up rate, especially when the central apneas are long. such a treatment in an experimental setting was effective against both primary central sleep apnea and csb-csa.  the benefit of asv in treating patients with heart failure and csb-csa is dependent on the suppression of the periodic breathing. pathogenesis of obstructive and central sleep apnea. [qxmd medline link]. [qxmd medline link]. [qxmd medline link]. [qxmd medline link]. [qxmd medline link].
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the purpose of this practice parameter is to review the available data for the treatment and management of csas in adults. csas in the absence of an identifiable etiology is referred to as “primary csas.” the presence and prevalence of this entity is uncertain. however, the number of studies on the clinical treatment outcomes for csas that meet this criterion is limited. complex sleep apnea was not included, as it is not currently listed as a disorder in the icsd-2. the result of each meta-analysis is shown in a figure with several components. no studies were found that met inclusion criteria on the treatment of primary csas with cpap, bilevel positive airway pressure in a spontaneous-timed mode (bpap-st), or asv. values and trade-offs: the literature on the use of pap therapy (cpap, bpap-st, asv) for the treatment of primary csas is very limited. although csas is not in and of itself an indication for crt, aop, or heart transplant, improvements in csas can be seen with the implementation of these interventions. post hoc analysis of the canpap data indicates that cpap treatment targeted to an ahi < 15 has a positive effect on transplant-free survival in patients with csas and chf. values and trade-offs: there were a limited number of studies that examined the effectiveness of bpap in the treatment of csas/csr. these devices target 90% of the calculated ventilatory assistance over a 3-minute moving window, to minimize hypo- and hyperventilation.
while there is no survival or long-term data available for asv at this time, there is a sufficient amount of data consistently demonstrating improvement in both the ahi and lvef. the studies reporting on the effect of oxygen on ahi fell into 2 groups: those that were randomized with control groups (rct)65,67,69,70 and those that were either non-randomized before-after trials,57,71–74 or randomized for treatment but without baseline measurements.66,68 all except 1 study75 reported a statistically significant decrease in ahi with oxygen supplementation. while the variable duration of treatment in each study limits recommendations in regard to duration of oxygen therapy, the overall positive direction of results with respect to reducing ahi and improving lvef confirms our recommendation. the data are presented in table 9. several alternate therapies have been examined for the treatment of csas/csr associated with chf. in addition to the pharmacological therapies, 2 studies reported on the effect of carbon dioxide on ahi and sleep. the available data examining the effect of crt on csas had a methodological limitation as the studies were not randomized, resulting in a moderate level of evidence. in a non-randomized study, kumagai et al.96 reported on the effect of oxygen in 11 peritoneal dialysis patients with sleep apnea syndrome. in a non-randomized treatment study without blinded scoring, pressman et al.97 reported the effect of 1 night of cpap on 6 renal failure patients with csas and mixed apneas. a small non-randomized study6 with limitations addressed the treatment of patients on opioids (120-420 mg/d) for chronic pain who had developed csas and were non-responsive to cpap. at this time, the amount of evidence is very low with respect to therapy for patients with csas associated with opioid use and precludes the formation of a recommendation. also, the level of evidence on csas not due to chf (i.e., primary, in conjunction with esrd or other medical conditions, or due to drug or substance) is very low, and more research is needed to enable recommendations to be more made with more certainty.
treatments for central sleep apnea might include: continuous positive airway pressure (cpap). this method, also used to treat obstructive treatments for central sleep apnea might involve treating existing conditions, using a device to assist breathing or using supplemental central sleep apnea treatment ; keep a healthy weight. ; avoid alcohol and sleeping pills, which make your airway more likely to collapse while, .
several different treatments aimed at central sleep apnea include positive airway pressure, adaptive servo ventilation (asv), oxygen, added dead treatment-emergent central sleep apnea: formerly known as complex sleep apnea, this is a type of central sleep apnea that starts to occur after very close clinical follow-up must be provided to consider the use of these hypnotic agents. 4.2 csas due to congestive heart failure (chf) including cheyne, .
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