That Deliver Confidence
CSA PATIENT IDENTIFICATION & TESTING
Identifying and treating Central Sleep Apnea (CSA) is critical to improving patient quality of life and preventing the cardiovascular decline caused by the disease.* CSA symptoms can be subtle and often overlap with co-existing symptoms that occur from other causes such as chronic heart failure, atrial fibrillation, and stroke. It is important to maintain a high index of suspicion for CSA in patients at risk.1
Common Risk Factors Associated with CSA1-3
- Recent heart failure (HF) hospitalization or symptomatic HF
- Frequent hospitalizations
- Atrial or ventricular arrhythmias
- Witnessed apneas
- Low ejection fraction
- Nocturia (> 2 per night)
CSA is diagnosed via a home or in-lab sleep study that is prescribed by a physician to determine if a patient has sleep apnea and if their primary type of apnea is CSA or obstructive sleep apnea (OSA).
During the sleep study, the number of apneic and hypopneic (abnormal shallow breathing) events per hour are counted and reported as the Apnea Hypopnea Index (AHI), the most common measure of severity of sleep apnea.
Home Sleep Apnea Test
(HSAT, Polygram, PG)
Completed at home
Measures oxygen, air flow
and movement of the chest and
In-Lab Sleep Study
Assesses sleep stage and other sleep
disorders in addition to sleep apnea
Requires overnight monitoring in a
Sleep testing metrics include:4
Apnea-Hypopnea Index (AHI)4
Number of apneas and hypopneas per hour of sleep
Mild (5 – 14 events/hour),
Moderate (AHI of 15 > to < 30 events/hour), and
Severe (AHI ≥ 30 events/hour)
≥10 second cessation of airflow, without effort
≥10 second cessation of airflow, while effort continues
Number of arousals per hour of sleep
30% or more reduction in airflow for 10 seconds with a 3% or 4% fall in oxygen saturation
Oxygen Desaturation Index (ODI) 3% or 4%
Number of times oxygen saturation drops by 3% or 4% or more per hour
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*remedē is not intended to prevent cardiovascular disease.
**Required to distinguish the type of sleep apnea
- Costanzo MR, Khayat R, Ponikowski P, et al. State-of-the-art review: Mechanisms and clinical consequences of untreated central sleep apnea in heart failure. J Am Coll Cardiol 2015;65:72-84.
- Khayat R, Jarjoura D, Porter K, et al. Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J 2015;36(23):1463-9.
- Bitter T, Westerheide N, Prinz C, et al. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur Heart J 2011;32:61-74.
- Iber C, Ancoli-Israel S, Chesson AL Jr., et al., for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine, 2007.