Primary central sleep apnoea syndrome is a distinct clinical entity characterised by recurrent central apnoeas without an identifiable secondary cause. In symptomatic patients, evidence-based pharmacological management targets the reduction of abnormal respiratory events and their daytime consequences.
This protocol applies to patients with confirmed primary central sleep apnoea syndrome — presenting with central apnoeas in the absence of an underlying condition responsible for the pattern.
In symptomatic patients, the approach involves a trial of specific pharmacological agents. Evidence for these agents comes largely from small, non-randomised studies. The full selection criteria, agent choice, and decision framework are in the complete protocol below.
DOI: 10.1183/20734735.0235-2023
Most of these studies are small, non-randomised trials examining four therapeutic options (acetazolamide, zolpidem, triazolam and CO2).
Acetazolamide at 250 mg·day−1 significantly reduced AHI and improved daytime sleepiness.
A separate study using a higher dose of acetazolamide (1000 mg·day−1) also demonstrated a decrease in the central apnoea index.
Although zolpidem and triazolam demonstrated reductions in central AHI in patients with primary CSA syndrome, the underlying therapeutic mechanism is not answered.
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