Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Families

Central sleep apnoea syndrome (CSA)

This information sheet from Great Ormond Street Hospital (GOSH) explains the causes, symptoms and treatment of central sleep apnoea syndrome (CSA) and where to get help.

What is central sleep a period of time usually in sleep. This apnoea syndrome? disorder may be caused by immaturity of the brainstem respiratory control centre or from Central sleep apnoea (CSA) is a disorder in other medical conditions. which there are pauses in breathing while nn Central sleep apnoea due to an underlying asleep – these are called apnoeas. The body medical condition affecting the nervous does not make an attempt to breathe during system (either brainstem or nerves going to these pauses. A certain number of apnoeic the muscles). Several medical conditions may pauses are normal in all infants, children and lead to CSA including neurological, craniofacial young people. For individuals diagnosed with abnormalities, neuromuscular conditions or CSA, these apnoeas are generally longer and injury/abnormality of the brainstem. more frequent. CSA occurs when the brain does nnCentral sleep apnoea due to an underlying not send the correct signals to the muscles that medical condition affecting chemoreception: control breathing. This differs from obstructive Several medical conditions may lead to CSA sleep apnoea (OSA) where normal breathing is including congenital central hypoventilation affected by obstruction in the upper air passage syndrome (CCHS), cardiac failure, obesity (throat). CSA is less common than OSA. hypoventilation syndrome (OHS) and Prader Willi syndrome, for example. What causes central sleep apnoea syndrome? What are the signs and CSA can be caused by a number of conditions symptoms of central sleep that affect the control centres for breathing apnoea syndrome? in the brain, known as the brainstem. The Common signs and symptoms of CSA include: brainstem is very sensitive to the chemicals in nnObserved episodes of stopped breathing or your blood (it is called chemoreception) and abnormal breathing patterns during sleep particularly to carbon dioxide (CO ). If your CO 2 2 nnAbrupt awakenings accompanied by falls too low (when you hyperventilate or after shortness of breath a big sigh, for example) there will be a central nnDifficulty staying asleep (insomnia) apnoea as a result to ensure it rises again. nnExcessive daytime sleepiness (hypersomnia) There are different types of CSA and these nnDifficulty concentrating include: nnMood changes nnApnoea of Infancy/Apnoea of Prematurity. nnMorning headaches Babies and young children have prolonged nnSnoring – although this may not be as apnoeic pauses or cycles of a few breaths prominent as in the presence of OSA and short pauses repeating regularly over

Sheet 1 of 2 Ref: 2016F1850 © GOSH NHS Foundation Trust November 2016 How is central sleep apnoea nnMedications. syndrome diagnosed? It is possible that medication may be available to help stimulate breathing in Breathing difficulties while sleeping can be patients with CSA. caused by a variety of medical conditions, so nnSurgical. a range of diagnostic tests may be needed If the brainstem is affected by either an to confirm or rule out CSA. Sleep studies are abnormality or a compression from the the main method of investigating CSA. A skull, such as in Chiari malformation, sleep study usually means an overnight stay surgical options may be available. in a sleep unit, where measurements of the child’s breathing during sleep are recorded by technologists/physiologists experienced What happens next? in working with children. The measurements If your child has been diagnosed with CSA are recorded using stick-on or wrap-around and has been treated or if it was decided to sensors and include respiratory rate, heart wait and follow progress, a follow-up sleep rate, oxygen saturation, chest wall movement, study will be arranged. This enables the airflow, measurement of CO , video and sound 2 medical professionals to assess if CSA has recording. The results are then interpreted by been successfully treated or if an alternative a paediatric sleep consultant, who can make a treatment is needed. diagnosis of CSA.

Further information How is central sleep and support apnoea syndrome treated? The British Lung Foundation offers support nnMaturity. and advice to anyone affected by a breathing Apnoea of prematurity/infancy may improve condition. Call their helpline on 03000 030 555 as the child gets older and the respiratory from Monday to Friday from 9am to 5pm or centre matures. It is likely the sleep visit their website at www.blf.org.uk. consultants will check this by organising The Sleep Apnoea Trust website (www.sleep- follow-up sleep studies. apnoea-trust.org) contains information about nnSupplemental oxygen. all types of sleep apnoea. Breathing extra oxygen during sleep may help reduce the number of apnoeic pauses and lessen the effects of CSA by improving the oxygen levels in the blood. nnBilevel Positive Airway Pressure (BPAP). BPAP is a form of breathing assistance using a ventilator device that delivers extra air pressure into the airway via a mask placed on the face. The level of air pressure provided varies on breathing in or breathing out. BPAP can also be set to deliver a breath if there has not been a breath within a certain number of seconds.

Compiled by the Respiratory Medicine team in collaboration with the Child and Family Information Group Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH www.gosh.nhs.uk

Sheet 2 of 2 Ref: 2016F1850 © GOSH NHS Foundation Trust November 2016