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What Medications Cause Central Sleep Apnea

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Medications That Affect Sleep Apnea

Understanding Mechanisms of Central Sleep Apnea – BAVLS

Currently, no medications have been developed that counteract the causes of Sleep Apnea, whether it is Obstructive or Central. There are, however, medicines that promote wakefulness and are used to treat some of the symptoms of Sleep Apnea like excessive daytime sleepiness and respiratory difficulty. None of these medications are meant to be taken as the sole treatment for your Sleep Apnea.

The Association Between Sleep Apnea And Mental Illness

Sleep apnea is closely tied to psychiatric pathology. Among patients with psychiatric disorders, the risk for sleep apnea is highoften because psychotropic medications can have sedating side effects.

Among those diagnosed with major depressive disorder and post-traumatic stress disorder , theres an increased prevalence of obstructive sleep apnea . Theres also a higher prevalence of psychiatric comorbid disorders in veteran populations with sleep apnea.

What Are The Causes Of Central Sleep Apnea

Central sleep apnea is a sleep disorder in which people stop breathing for 10 seconds or more at a time. It is caused by a blockage in the throat or nose that prevents airflow during sleep. The most common cause of central sleep apnea is a large tongue, but it can also be caused by a hernia, enlarged tonsils , or other medical conditions like obesity. One theory suggests that CSA is caused by a problem with the muscles in the airway that keep it open.

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How The Intervention Might Work

Pharmacological agents with very distinct mechanisms of action may act on ventilatory control and sleep stability. Hypnotics such as triazolam and zolpidem consolidate the sleep state, by reducing fluctuations between wakefulness and unstable sleep. This may exert a protective action, considering that frequent arousals are associated with increased chemoresponsiveness, leading to the pattern of hyperventilation and subsequent hypoventilation . In fact, periodic breathing predominates during light nonrapid eye movement sleep, disappearing during rapid eye movement sleep .

Respiratory stimulants may also exert a beneficial action in mitigating central apnoeas. Metabolic acidosis induced by acetazolamide increases the apnoeic threshold of PCO2, leading to the reduction of central apnoeas . The mechanism of action explaining the reason why theophylline improves central apnoeas is not completely understood. Theophylline competes with adenosine, which, in turn, depresses ventilatory function . It is reasonable to attribute the ventilatory stimulation caused by theophylline to adenosine blockage at some extent .

How Is Central Sleep Apnea Different From Obstructive Sleep Apnea

Treatment Options for Central Sleep Apnea

In obstructive sleep apnea, a person makes a notable effort to breathe, but the airway in the back of the throat is blocked. The blockage in the back of the throat causes an obstruction to our windpipe, which leads to sleep fragmentation and a disturbed oxygen balance in the body.

In central sleep apnea, the problem isnt a blocked airway. Instead, pauses in breathing occur because the brain and the muscles that control breathing arent functioning properly. As a result, there is no normal respiratory effort, which is in clear contrast to OSA.

While OSA and CSA are separate conditions, they can arise at the same time in what is known as mixed sleep apnea. In addition, treatment of OSA with continuous positive airway pressure , can induce central sleep apnea, and this is called treatment-emergent central sleep apnea.

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Central Sleep Apnea: Potential Impact Of Benzodiazepines Opioids And Cyp3a4 Inhibitors

Independent Senior Care Consultant Pharmacist and President of MZ Associates, Inc.Norwich, New YorkChair 2014-2015, Board of Commissioners, Commission for Certification in Geriatric PharmacyRecipient of the Excellence in Geriatric Pharmacy Practice Award from the Commission for Certification in Geriatric Pharmacy.

US Pharm. 2015 40:21-24.

Sleep-disordered breathing refers to a spectrum of periodic respiratory events that occur during sleep. These events range from mild snoring to partial cessation of airflow to complete cessation of airflow .1Obstructive sleep apnea , constituting 90% of sleep apnea cases, is airflow cessation as a result of airway closure in spite of adequate respiratory muscle effort.2Central sleep apnea encompasses a heterogeneous group of sleep-related breathing disorders in which respiratory effort is diminished or absent during sleep and occurs in an intermittent or cyclical manner.3,4

While CSA is most often associated with obstructive sleep apnea syndromes, it is also associated with or caused by an underlying medical condition , a recent ascent to high altitude, drugs, or substance abuse.3 Primary CSA, which is considered a rare condition, is not entirely understood with regard to etiology.3 Individuals with cardiac, respiratory, or neurologic disease may be at greater risk of CSA.5

Obstructive Central Sleep Apnea

Obstructive central sleep apnea is a type of central sleep apnea that is caused by a blockage of the airway at the neck. This prevents oxygen from reaching the brain, and can lead to fatigue, poor concentration, and problems with memory and coordination. OCSAs are more difficult to treat than other types of central sleep apnea, but treatment can help improve sleep quality and functioning. People with OCSA often have high levels of oxygen in their blood but low levels of carbon dioxide, which can lead to fatigue and morning headaches.

Obstructive sleep apnea is a disorder in which breathing is interrupted during sleep. Obstructive central apnea is the most severe form of obstructive sleep apnea, in which breathing is stopped completely. People with obstructive sleep apnea may experience frequent episodes of sleep gasping, snoring, and loud breathing. While most people with obstructive sleep apnea experience mild symptoms that can be managed with treatment, some people have more severe cases and require surgery. OCA can lead to heart failure, stroke, diabetes, and other serious health problems.

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Idiopathic Central Sleep Apnea

Unfortunately, theres no known cause for this particular type of central sleep apnea.

One should never ignore central sleep apnea. This is a serious respiratory disorder that could lead to many other complications and a significant drop in the quality of life. Severe fatigue and daytime drowsiness are commonly associated with central sleep apnea and can cause a lot of problems for the affected individual. Whats worse, the lack of necessary oxygen during sleep could end up affecting your heart health, which is even more dangerous when an underlying heart condition is present.

Table 4 Drugs Reported To Be Associated With Sleep Apnea

Severe Central Sleep Apnea Treatment *1 year later

Alcohol Neuroleptics Sodium oxybate

Opioids have been shown as cause of central sleep apnea, which resolves after discontinuation of the drug . The overall prevalence of central sleep apnea in patients taking chronic opioids is 24% . Sleep apnea has been reported in patients receiving methadone as opiate replacement therapy, and prescription of benzodiazepine is not recommended in such situations. Polysomnography may unmask adverse pharmacological effects, eg, central sleep apnea due to central depressant effect of high dose baclofen that resolves with reduction of dose .

Sedative-hypnotics, anesthetics, and analgesics alter sleep architecture, which likely contributes to abnormal postoperative sleep architecture with exacerbation of obstructive sleep apnea and postoperative complications . Main drugs involved in case reports of drug-induced sleep apnea in the French pharmacovigilance database are benzodiazepines, neuroleptics, and opioids .

Sleep paralysis. Sleep paralysis is the transient inability to move or speak during the onset of sleep, or on wakening. It may occur as a manifestation of narcolepsy and is often associated with mental disorder. Isolated sleep paralysis during awakening from sleep may occur in the absence of other clinical features of narcolepsy. It is more common in users of anxiolytic medications.

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Sleep Apnea: 7 Things That Can Make It Worse

Obstructive sleep apnea, also called OSA, is a disorder in which a person may stop breathing several times while they are sleeping. The condition is a serious health problem that affects people of all ages, including children. If you suspect that you have sleep apnea, your doctor may send you to a sleep specialist who will conduct a sleep study to determine if you have OSA. This is the typical approach that your health care provider uses to confirm a diagnosis of apnea.

It is also helpful to understand that lifestyle habits and health conditions can worsen apnea. Some of these health habits are factors that you can control, so it’s important to find out what can make sleep apnea worse.

1. Obesity: Being obese can also worsen sleep apnea, so it is important to manage your weight if you are significantly overweight. Extra weight can result in excess tissues in and around your airway, which negatively impacts your airway as your body relaxes at night. What’s more, sleep apnea can actually lead to weight gain. If you’re struggling with weight gain, talk to your doctor about good nutrition so that you can maintain a healthy weight.

2. Alcohol: Alcohol is another type of muscle relaxant, and this can create problems for people who deal with apnea. Drinking alcohol can cause your airway to relax too much, which can lead to obstruction. If you are struggling with OSA, it is best to avoid drinking alcohol altogether.

How To Diagnose Central Sleep Apnea

Sleep doctors have training and expertise in this area. The doctor will review your medical history and symptoms. In the case of high-altitude periodic breathing, the detailed history alone should be enough to detect the problem. If needed, the doctor will schedule you for a sleep study.

Most of the causes of CSA are serious conditions that should be evaluated and treated. A sleep doctor can put together a treatment plan just for you. First, she must evaluate the causes of CSA and look for other conditions that create similar problems with sleeping. These include the following:

  • Another sleep disorder
  • A mental health disorder
  • Substance abuse

The doctor will need to know your symptoms and how long you have had them. She will also want to know if your symptoms began at the same time as other medical problems or when you slept at a high altitude.

Get information from those who sleep with you or have seen you sleep. This includes spouses, relatives, friends, teammates, and roommates. You will also need to provide a complete medical history.

Keep a sleep diary for two weeks. Include the following information:

  • What time you went to bed each night
  • What time you got up in the morning
  • How many times you woke up during the night
  • Whether you felt rested when you woke up
  • If you took naps during the day
  • Whether you felt sleepy or rested throughout the day

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Can Medications Cause Sleep Apnea

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Which Medications Are Used In The Treatment Of Central Sleep Apnea Syndromes

How Common Is Central Sleep Apnea

Due to the heterogeneity of the central sleep apnea syndromes, different medications have been used under different circumstances. No single medication can be considered a drug of choice. Several different medications aimed at improving central sleep apnea include acetazolamide, theophylline, and sedative-hypnotic agents.

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Table 2 Drugs Associated With Vivid Dreams And Nightmares

Analgesics

Hypnotic withdrawal

From:

Sleepwalking. Sleepwalking occurs out of deep NREM of sleep and apparently represents a disorder of arousal. It is one form of parasomnia. Subjects with epilepsy and those with a past or family history of sleepwalking are more liable to manifest this as an adverse reaction to drugs. A systematic review of the literature identified 29 drugs, primarily in 4 classes as possible triggers for sleepwalking: benzodiazepine receptor agonists and other gamma aminobutyric acid modulators antidepressants and other serotonergic agents antipsychotics and beta-blockers . The strongest evidence for medication-induced sleepwalking was for zolpidem and sodium oxybate. A case report of a patient who suffered a fractured leg during sleepwalking and literature review suggest that propranolol, a beta blocker, can trigger somnambulism, especially if it already occurred in the patients past medical history . The authors recommend listing somnambulism as a potential side effect of propranolol and treating sleepwalking as an absolute contraindication of propranolol.

Sleepwalking has been reported in association with the use of the drugs listed in Table 3.

Central Sleep Apnea Diagnosis

A central sleep apnea diagnosis can be completed by licensed physicians. The first step in a central sleep apnea diagnosis requires an examination, which generally includes the individual staying overnight in a sleep laboratory to receive a sleep study, or polysomnography, administered by a technician.

Periods of breathing cessation are measured in frequency during the sleep study, which will allow the technician to help determine what type of sleep apnea is present.In central sleep apnea, the interruption in breathing is associated with physically being unable to restart the cycle. A polysomnogram will show the relation between the cessation of airflow through the nose and mouth, as well as the absence of muscle movement in the rib cage and abdominal area.

Since central sleep apnea is frequently associated with heart, lung, or kidney diseases, there are other tests that are done with polysomnography, including:

  • Lung function tests

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Data Collection And Analysis

Selection of studies

Two review authors will screen the titles and abstracts of the search results independently and code them as ‘retrieve’ or ‘do not retrieve’. We will retrieve the fulltext study reports of all potentially eligible studies and two review authors will independently screen them for inclusion, recording the reasons for exclusion of ineligible studies. We will resolve any disagreement through discussion or, if required, we will consult a third person/review author . We will identify and exclude duplicates and collate multiple reports of the same study so that each study, rather than each report, is the unit of interest in the review. We will record the selection process in sufficient detail to complete a PRISMA flow diagram and ‘Characteristics of excluded studies’ table .

Data extraction and management

We will use a data collection form for study characteristics and outcome data adapted from EPOC 2013, which has been piloted on at least one study in the review. One review author will extract the following study characteristics from included studies.

Assessment of risk of bias in included studies

Two review authors will assess risk of bias independently for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions . We will resolve any disagreements by discussion or by involving another author . We will assess the risk of bias according to the following domains:

How Common Is Central Sleep Apnea

Managing Central Sleep Apnea With Advancements In Treatment of Obstructive Sleep Apnea

While the exact number of people with central sleep apnea is unknown, it is estimated that about .9% of people over 40 in the United States have the condition. Though it affects both men and women, it occurs more often in men of greater than 65 years old. People who have a heart condition, use narcotics, suffer from a stroke, live in high altitudes, or use CPAP are at greater risk for central sleep apnea.

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How Is Central Sleep Apnea Diagnosed

A definitive diagnosis of CSA is made using an in-lab polysomnography, which is a detailed sleep study that measures breathing, respiratory effort, electrocardiogram, heart rate, oxygen, eye movement activity, muscle activity, and electrical activity of the brain during an overnight stay in a sleep clinic.

Because central sleep apnea can be tied to several health problems, a healthcare provider may also recommend other tests, such as a brain scan or an echocardiogram of the heart to determine the underlying cause.

Anyone who has noticed potential symptoms of central sleep apnea should speak with a doctor who can review their situation and determine if any diagnostic testing is appropriate.

Treatment Options For Central Sleep Apnea

A respiratory disorder that makes one stop and start breathing repeatedly during sleep is known as central sleep apnea. There are other types of this disorder such as obstructive sleep apnea, but the so-called central one occurs due to the poor connection between the brain and breathing control muscles. Its much rarer than the obstructive sleep apnea, but also more concerning. After all, some of the more serious causes of central sleep apnea include conditions such as stroke or heart failure. In that respect, treating the preexisting conditions could also end up treating central sleep apnea, together with breathing devices and supplemental oxygen.

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Why It Is Important To Do This Review

CSA associated with CSB in the context of CHF is considered a severity marker and indicative of poor prognosis . It is not entirely clear whether treating CSACSB in this population improves survival, which would therefore be of utmost importance. Additionally, sleep fragmentation due to CSA may lead to difficulty maintaining sleep and daytime sleepiness, impacting negatively in quality of life. Some therapies for CSAS are associated with improvement of quality of life , however it is still not clear whether and to what extent pharmacological therapies might improve quality of life.

Much of the evidence on the effectiveness of pharmacological agents for CSAS is derived from nonrandomised studies or from randomised studies with methodological limitations. A comprehensive search in the literature and a critical appraisal of the quality of studies following the recommendations proposed by Cochrane will provide a reliable summary of the available evidence to guide decision making.

How Do You Get Rid Of Central Sleep Apnea

WebMD asks PCSI what causes central sleep apnea?

Central sleep apnea is a condition in which breathing becomes irregular during sleep, potentially leading to snoring and fatigue. A number of treatments are available, but many people find they need more than one to be effective. Here are five tips for getting rid of central sleep apnea: Make sure your sleeping environment is comfortable. If you are overweight, try to lose weight before trying to get rid of central sleep apnea. If you sleep on your back, consider a different position. If you snore, talk with your doctor about a CPAP machine that keeps air moving through your airway during sleep. For some people, complex sleep apnea goes away with continued use of a CPAP device. Get rid of tobacco and other substances that can reduce breathing ability. Try not to drink caffeine after noon. If you drink alcohol, make sure it is low in alcohol.

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