Paediatr Respir Rev 30: 49 - 57, 2019. doi: 10.1016 / j. prrv.2018.07.005 Pathophysiology of Central Sleep Apnea Unlike with obstructive sleep apnea, in which airway obstruction restricts airflow, central sleep apnea (CSA) is caused by alterations in respiratory drive, which during sleep is highly dependent on carbon dioxide levels.