Treatment

Treatment is not usually required for central sleep apnoeas with a normal or low Pco2 unless they cause significant insomnia or excessive daytime sleepiness due to sleep fragmentation. In these situations the treatment options are as follows.

1 Modification of sleep pattern. Consolidation of NREM sleep with benzodiazepines and similar drugs minimizes the number of sleep-stage shifts. Reduction of the duration of REM sleep by antidepressants may be effective if REM sleep is when most of the apnoeas occur.

2 Modification of respiratory drive. Relief of hypoxia with supplemental oxygen usually given through nasal cannulae reduces the hypoxic drive. Theophyllines and acetazolamide lower the apnoeic threshold for carbon dioxide and may be of help.

3 Nasal continuous positive airway pressure (CPAP) treatment. This modifies upper airway reflexes, and increases the lung volume and the quantity of oxygen stored in the lungs. It may be effective by itself or in combination with nocturnal oxygen, and possibly 0.5-1% carbon dioxide [1].

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