Should Carbon Dioxide be Used to Treat Central Sleep Apnea and Cheyn-Stokes Periodic Breathing?

Central Sleep Apnea is often considered a neurologic disorder where the brain forgets to breathe. Central Sleep Apnea can occur when a patient is placed on too high a level of CPAP pressure as well. The CPAP blows off the Carbon Dioxide (CO2) which causes the drive to breathe. Breakthru Central Sleep Apneas then occur.

Therapeutic and well controllled CO2 therapy could be considered for all patients with mixed sleep apnea, Cheyne-stokes periododic breathing, central sleep apnea, comple sleep apnea and breakthru central apneas.

Adaptive Servo ventilation (ASV) could still be used as a fail-safe but patients breating on their own due to physiologic CO@ levels is certainly the ideal.

Oral Appliance may also be affected by a CO2 phenomenom. Appliances like the TAP that do not allow mouth opening are often much more successful then Herbst appliances and Somnomed Appliances that allow the mouth to open. It may be that mouth breathing with the jaw forward decreases CO2 levels causing an increase in central sleep apneas

If the CO2 concentration in inspired air and can increase the carbon dioxide above the apneic threshold it would be a cure. CO2 has been shown to be effective against central sleep apnea (CSA) and Cheyne Stokes Breathing-CSA. A miniscule increase in PaCO2 (approximately 1.5-2 mm Hg) can effectively stabilize breathing patterns. Adding supplemental carbon dioxide (5%) can give similar results, but carbon dioxide delivery devices ,in terms of accuracy and safetyare not yet perfected. In patients with heart failure considerations could be given to adding both CO2 and Oxygen to prevent over stressing weakened heart muscles.