Ticagrelor-Associated Central Sleep Apnea: Mechanisms, Clinical Evidence, and Implications for Sleep Medicine

Ticagrelor is a reversible P2Y12 receptor antagonist used for antiplatelet therapy and is well recognized to cause dyspnea. Emerging concern has focused on a possible association between ticagrelor and central sleep apnea, Cheyne-Stokes respiration, and other manifestations of ventilatory instability. This narrative review examines the clinical evidence for ticagrelor-associated central sleep apnea and the respiratory-control mechanisms proposed to underlie this association. A structured literature search was performed using PubMed, with Google Scholar and citation tracking used for supplementary discovery. Human clinical, physiologic, pharmacovigilance, and mechanistic evidence was synthesized qualitatively according to study design and evidentiary strength. Overall, the literature supports a possible association between ticagrelor exposure and central respiratory instability, although the incidence, clinical significance, and susceptibility factors remain uncertain. Enhanced ventilatory chemosensitivity and ventilatory overshoot provide a plausible physiologic framework, whereas equilibrative nucleoside transporter 1 inhibition and altered adenosine signaling remain proposed rather than established mechanisms in humans. Ticagrelor-associated central sleep apnea should therefore be regarded as an emerging medication-associated respiratory phenotype requiring cautious clinical interpretation. Prospective studies using standardized respiratory phenotyping, appropriate comparator groups, serial assessment, and clinically meaningful outcomes are needed to clarify susceptibility, reversibility, mechanisms, and clinical consequences.