title: Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep.
abstract: The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a "marker" of disease severity or a "mediator" of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.
authors.affiliation: Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany randerath@klinik-bethanien.de.|These authors contributed equally.|Task force chairs.
authors.forename: Winfried
authors.initials: W
authors.lastname: Randerath
authors.affiliation: Dept of Pulmonary Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.|These authors contributed equally.|Task force chairs.
authors.forename: Johan
authors.initials: J
authors.lastname: Verbraecken
authors.affiliation: Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.|Lung Clinic Immenhausen, Krs. Kassel, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Andreas
authors.affiliation: Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
authors.affiliation: University Hospital Zurich, Dept of Pulmonology and Sleep Disorders Center, Zurich, Switzerland.
authors.forename: Konrad E
authors.initials: KE
authors.lastname: Bloch
authors.affiliation: Dept of Internal and Pulmonary Medicine, Kantonsspital Glarus, Glarus, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brack
authors.affiliation: Dept of Pulmonary Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Bertien
authors.initials: B
authors.lastname: Buyse
authors.affiliation: Dept of Pulmonary Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Backer
authors.affiliation: Neuroscience Research Australia (NeuRA) and the University of New South Wales, Sydney, Australia.
authors.forename: Danny Joel
authors.initials: DJ
authors.lastname: Eckert
authors.affiliation: Sleep Disorders Center, Dept of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
authors.affiliation: Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Hagmeyer
authors.affiliation: Sleep Disorders Center, Dept of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hedner
authors.affiliation: Center for Healthy Aging and Danish Center for Sleep Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Poul
authors.initials: P
authors.lastname: Jennum
authors.affiliation: Dept of Cardiology, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano, Pavia, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: La Rovere
authors.affiliation: Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany.
authors.forename: Carla
authors.initials: C
authors.lastname: Miltz
authors.affiliation: Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital and University College Dublin, Dublin, Ireland.
authors.forename: Walter T
authors.initials: WT
authors.lastname: McNicholas
authors.affiliation: Laboratori del Son, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Montserrat
authors.affiliation: General Respiratory and Transplantation, Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Naughton
authors.affiliation: Laboratoire du sommeil explorations fonct. respire., Centre Hospitalier Universitaire Grenoble, Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pepin
authors.affiliation: Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: Pevernagie
authors.affiliation: Dept of Internal Medicine, Agaplesion Bethesda Hospital Wuppertal, Wuppertal, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Sanner
authors.affiliation: Dept of Internal Medicine, Agaplesion Bethesda Hospital Wuppertal, Wuppertal, Germany.
authors.forename: Dries
authors.initials: D
authors.lastname: Testelmans
authors.affiliation: Institute of Social and Preventive Medicine, Universtity of Bern, Bern, Switzerland.
authors.forename: Thomy
authors.initials: T
authors.lastname: Tonia
authors.affiliation: Dept of Pulmonary Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Vrijsen
authors.affiliation: Dept of Pulmonology/Home Mechanical Ventilation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Wijkstra
authors.affiliation: Laboratoire du sommeil explorations fonct. respire., Centre Hospitalier Universitaire Grenoble, Grenoble, France.|Task force chairs.
authors.forename: Patrick
authors.initials: P
authors.lastname: Levy
mesh_terms: D026683:Advisory Committees; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005060:Europe; D006801:Humans; D007040:Hypoventilation / Q000209:etiology; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D017410:Practice Guidelines as Topic; D012196:Review Literature as Topic; D012890:Sleep; D020182:Sleep Apnea, Central / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid