food energy and demand for it during that time and thereby promoting weight gain, and b] reduces sleep quality and recovery per time unit of sleep, resulting in sleepiness or fatigue that may prompt affected people to eat more in an attempt to increase short-term energy levels. correlation with cardiac disorders: atrial fibrillation (af): a study in the medical journal sleep found that the prevalence of atrial fibrillation among patients with idiopathic central sleep apnea was significantly higher than the prevalence among patients with obstructive sleep apnea or no sleep apnea (27%, 1.7%, and 3.3%, respectively). the study was based on 180 subjects with 60 people in each of the 3 groups. possible explanations for the association between csa and af include a causal relationship in one direction or the other between the two conditions or a common cause involving an abnormality of central cardiorespiratory regulation. adults with congestive heart failure are at risk for a form of central apnea called cheyne-stokes respiration, which manifests itself both during sleep and during waking hours. cheyne-stokes respiration is characterized by periodic breathing featuring recurrent episodes of apnea alternating with episodes of rapid breathing. there is good evidence that replacement of the failing heart (heart transplant) cures central apnea in these patients. temporary measures (e.g., those taken pending the availability of an organ donor) include the administration of drugs whose effects include respiratory stimulation, although these drugs are not universally effective in reducing the severity of cheyne-stokes apneas. congenital central hypoventilation syndrome congenital central hypoventilation syndrome (cchs), often referred to by its older name "ondine's curse," is a rare and very severe inborn form of abnormal interruption and reduction in breathing during sleep. this condition involves a specific homeobox gene, phox2b, which guides maturation of the autonomic nervous system; certain loss-of-function mutations interfere with the brain's development of the ability to effectively control breathing. there may be a recognizable pattern of facial features among individuals affected by this syndrome. once almost uniformly fatal, cchs is now treatable. children who have it must have tracheotomies and access to mechanical ventilation on respirators while sleeping, but most do not need to use a respirator while awake. the use of a diaphragmatic pacemaker may offer an alternative for some patients. when pacemakers have enabled some children to sleep without the use of a mechanical respirator, reported cases still required the tracheotomy to remain in place because the vocal cords did not move apart with inhalation. persons with the syndrome who survive to adulthood are strongly instructed to avoid certain condition-aggravating factors, such as alcohol use, which can easily prove lethal. treatment after a patient receives a diagnosis, the diagnosing physician can provide different options for treatment. if central sleep apnea is medication-induced (e.g., opioids), reducing the dose or eventual withdrawal of the offending medication often improves csa. the fda has recently approved a pacemaker-like implantable device called the remedē system for adult patients with moderate to severe central sleep apnea. after a commonly performed procedure, the device stimulates a nerve in the chest (phrenic nerve) to send signals to the large muscle that controls breathing (the diaphragm). it monitors respiratory signals during sleep and helps restore normal breathing patterns. the device is silent, activates automatically during the night, and does not require the patient to wear a mask. mechanical regulation of airflow and/or airway pressure: treatment for central sleep apnea differs in that the device is set not at one constant optimal pressure but rather at two different settings, one for inhalation (ipap) and for exhalation (epap), maintaining normal breathing rhythm by inflating the patient's lungs at regular intervals whose specifics, such as the breathing rate and the duration of a single breath, can be programmed. devices tailored to this purpose are known as bipap ("bilevel positive airway pressure") devices. both cpap and bipap devices can be connected to a humidifier to humidify and heat the inhaled air, thus reducing unpleasant symptoms such as a sore throat or blocked nose that can result from inhaling cold, dry air. cpap and bipap devices can trigger central apneas in those with obstructive sleep apnea requiring the use of an asv (adaptive servo ventilation) device, which is also the proper machine for those who have central sleep apnea or mixed/complex apnea. epidemiology central sleep apnea is less prevalent than obstructive sleep apnea. in one study, csa is stated to have a prevalence of 0.9% in comparison to osa. there are many factors that increase the risk of developing csa. chronic opioid use produces a mean prevalence in central sleep apnea development of 24%. an estimate of 10% of chronic kidney disease (ckd) patients have a csa diagnosis. cohort studies of stroke patients show a 70% development rate of csa within 72 hours of the stroke event, although csa was detected in less than 17% after 3 months of follow-up. another cohort study from the sleep heart healthy study showed incidence of csa in heart failure patients to be 0.9%. infancy central sleep apnea is common in preterm, newborn, and infancy stages but a decrease in risk is found with aging and maturity of the central nervous system. underlying neurological disorders are the most common cause of csa in full term infants. of the apnea related events in preterm infants born at less than 29 weeks, 25% are central in origin. childhood csa is less common after 2 years of age. the prevalence of csa in healthy children aging 10 to 18 years is 30%. children with underlying medical conditions fall under a prevalence rate of 4-6%. for children diagnosed with prader-willi syndrome (pws), csa is more common and can occur in up to 53% of cases. adulthood research shows that rates of sleep apnea are higher in adults over the age of 65 years, due to older individuals having higher risks of developing csa due to pre-existing medical conditions. recorded prevalence in a cohort study of 2,911 men over the age of 65 was 7.5%. there is reduced risk of csa in women, and a higher incidence in men. one study showed the incidence of csa in men was 7.8% and 0.3% in women, stating a difference in hormones have an effect on the apneic threshold (at) for apnea.