Central Sleep Apnea 385
use of long-acting opioid medications  is often associated with im pairment of respiratory con-
trol leading to central sleep apnea.
Associated Features Supporting Diagnosis
Individuals with central sleep apnea hypopneas can manifest with sleepiness or insomnia.
There can be complaints of sleep fragment ation, including awakening with dyspnea.
Some individuals are asymptomatic. Obstruct ive sleep apnea hypopnea can coexist with
Cheyne-Stokes breathing, and thus snoring and abruptly terminating apneas may be ob-
served during sleep. 
Prevalence
The prevalence of idiopathic central sleep apnea is unknown but thought to be rare. The
prevalence of Cheyne-Stokes breathing is high in individuals with depressed cardiac ven-
tricular ejection fraction. In individuals with an ejection fraction of less than 45%, the prev-
alence has been reported to be 20% or high er. The male-to-female ratio for prevalence is
even more highly skewed toward males than for obstructive sleep apnea hypopnea. Prev-
alence increases with age, and most patients are older than 60 years. Cheyne-Stokes breath-
ing occurs in approximately 20% of individu als with acute stroke. Central sleep apnea
comorbid with opioid use occurs in approxim ately 30% of individuals taking chronic opi-
oids for nonmalignant pain and similarly in individuals receiving methadone mainte-
nance therapy. 
Development and Course
The onset of Cheyne-Stokes breathing appears tied to the deve lopment of heart failure. The
Cheyne-Stokes breathing pattern is associated with oscillations in heart rate, blood pres-
sure and oxygen desaturation, and elevated sy mpathetic nervous system activity that can