Primary Central Sleep Apnea (previously Breathing Related Sleep Disorder)
A. The patient reports at least one of the following:
1. excessive daytime sleepiness
2. frequent arousals and awakenings during sleep or insomnia complaints
3. awakening short of breath
B. Polysomnography shows five or more central apneas per hour of sleep
C. The disorder is not better explained by another current sleep disorder, medical or neurological disorder, medication use, or substance use disorder. Distinguishing obstructive from central sleep apnea hypopnea syndrome is recommended based on the following:
1. To harmonize with ICD and ICSD;
2. Evidence for a role for genetic polymorphisms in genes influencing neural crest cell development in congenital central sleep apnea (and its potential relevance to other central sleep apnea syndromes) with no overlapping genetic polymorphisms yet reported for obstructive sleep apnea.
3. Risk factors differ for obstructive and central sleep apnea. Obstructive sleep apnea is strongly associated with snoring, obesity, increased waist girth and male gender. Central sleep apnea is most strongly associated with advanced age, heart failure, and diabetes.
4.Cardiac Outcomes associated with obstructive and central differ. For example, obstructive sleep apnea is associated with ventricular ectopy while central sleep apnea is more strongly associated with atrial fibrillation.
Relationship to International Classification of Sleep Disorders 2nd Edition
327.21
References
1. Gaultier C. et al. Genetics and early disturbances of breathing control. Pediatr Res. 2004 May;55(5):729-33.
2. Mehra R. et al. Prevalence and correlates of sleep-disordered breathing in older men: osteoporotic fractures in men sleep study. J Am Geriatr Soc. 2007 Sep;55(9):1356-64.
3. Mehra R. et al. Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study.
Arch Intern Med. 2009 Jun 22;169(12):1147-55.
4. Resnick HE. et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study
Diabetes Care. 2003 Mar;26(3):702-9.
This new disorder is not listed in DSM-IV and was previously subsumed under Breathing Related Sleep Disorder.