Evaluation and Management of Central Sleep Apnea in Adults: A Comprehensive Review

Central sleep apnea (CSA) is an encompasses a spectrum of sleep-disordered breathing disordersdefined by repetitive episodes of reduced or absent ventilatory drive during sleep. This narrative review presents current knowledge about the pathophysiology, diagnostics, classification, and treatment of adult CSA. Methods: The literature was chosen from peer-reviewed studies, clinical trials, guidelines, and systematic reviews on adult CSA with particular focus on CSA related to heart failure, opioids, high altitude, treatment-emergent CSA, positive airway pressure modes, pharmacological therapy, and phrenic nerve stimulation. Results: Current data suggest that the phenotype-directed approach with PSG, respiratory effort, comorbidity, and pharmacological history assessment allowed for the classification of CSA syndromes in relation to hyperventilation, hypoventilation, treatment-induced, and cause-dependent forms. CPAP, oxygen, BPAP-ST, ASV, acetazolamide, and transvenous phrenic nerve stimulators have different efficacy in certain CSA types with unclear data on the long-term cardiovascular outcomes, especially in patients with heart failure and exposure to opioids. Conclusions: Adult CSA management should be individualized according to mechanism, comorbidity profile, symptom burden, treatment safety, and measurable clinical outcomes.