Idiopathic central sleep apnea has been reported to cause symptoms of disrupted sleep, in- cluding insomnia and sleepiness. Cheyne-Stokes breathing with comorbid heart failure has been associated with excessive sleepiness, fatigue, and insomnia, although many in— dividuals may be asymptomatic. Coexistence of heart failure and Cheyne-Stokes breath- ing may be associated with increased cardiac arrhythmias and increased mortality or cardiac transplantation. Individuals with central sleep apnea comorbid with opioid use may present with symptoms of sleepiness or insomnia.
disorders, other sleep disorders, and medical conditions and mental disorders that cause sleep fragmentation, sleepiness, and fatigue. This is achieved using polysomnography.
Other breathing-related sleep disorders and sleep disorders. Central sleep apnea can be distinguished from obstructive sleep apnea hypopnea by the presence of at least five central apneas per hour of sleep. These conditions may co-occur, but central sleep apnea is considered to predominate when the ratio of central to obstructive respiratory events ex- ceeds 50%.
Cheyne-Stokes breathing can be distinguished from other mental disorders, including other sleep disorders, and other medical conditions that cause sleep fragmentation, sleep- iness, and fatigue based on the presence of a predisposing condition (e.g., heart failure or stroke) and signs and polysomnographic evidence of the characteristic breathing pattern.
from insomnia due to other medical conditions. High-altitude periodic breathing has a pattern that resembles Cheyne-Stokes breathing but has a shorter cycle time, occurs only at high altitude, and is not associated with heart failure.
Central sleep apnea comorbid with opioid use can be differentiated from other types of breathing-related sleep disorders based on the use of long-acting opioid medications in conjunction with polysomnographic evidence of central apneas and periodic or ataxic breathing. It can be distinguished from insomnia due to drug or substance use based on polysomnographic evidence of central sleep apnea.
Central sleep apnea disorders are frequently present in users of long-acting opioids, such as methadone. Individuals taking these medications have a sleep-related breathing disor- der that could contribute to sleep disturbances and symptoms such as sleepiness, confu- sion, and depression. While the individual is asleep, breathing patterns such as central apneas, periodic apneas, and ataxic breathing may be observed. Obstructive sleep apnea hypopnea may coexist with central sleep apnea, and features consistent with this condi- tion can also be present (see ”Obstructive Sleep Apnea Hypopnea" earlier in this chapter).
Cheyne-Stokes breathing is more commonly observed in association with conditions that include heart failure, stroke, and renal failure and is seen more frequently in individuals with atrial fibrillation. Individuals with Cheyne-Stokes breathing are more likely to be older, to be male, and to have lower weight than individuals with obstructive sleep apnea hypopnea.
A. Polysomnograpy demonstrates episodes of decreased respiration associated with eI- evated 002 levels. (Note: In the absence of objective measurement of 002, persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)
B. The disturbance is not better explained by another current sleep disorder.
Specify whether: 327.24 (647.34) Idiopathic hypoventilation: This subtype is not attributable to any readily identified condition.
327.25 (647.35) Congenital central alveolar hypoventilation: This subtype is a rare congenital disorder in which the individual typically presents in the perinatal period with shallow breathing, or cyanosis and apnea during sleep.