Central sleep apnoeas

Description

Central sleep apnoeas are characterised by reduction or cessation of airflow due to absent or reduced respiratory effort. Central apnoea (cessation of airflow) or hypopnea (reduction in airflow) may occur in a cyclical or intermittent fashion. Patients with central sleep apnoea of various etiologies may also exhibit obstructive events, in which case diagnoses of both central sleep apnoea and obstructive sleep apnoea may be given. Note: A definitive diagnosis requires objective evidence based on polysomnography. [1]

Subcategories

• 7A40.0 Primary central sleep apnoea

  Primary central sleep apnoea is of unknown etiology (idiopathic) and is characterised by recurrent, predominantly central apnoeas. Airflow and respiratory effort cease simultaneously in a repetitive fashion over the course of the night. The recurrent episodes of apnoea (more than five per hour) and associated arousals are sufficiently severe to cause symptoms such as daytime sleepiness, disturbed sleep, awakening with dyspnoea, or snoring. Note: A definitive diagnosis requires objective evidence based on polysomnography. [1]

• 7A40.1 Primary central sleep apnoea of infancy

  Primary central sleep apnoea of infancy is characterised by prolonged (> 20 seconds), predominantly central apnoeas or periodic breathing during more than 5% of total sleep time in an infant of at least 37 weeks conceptional age. These events are typically associated with physiological compromise (hypoxemia, bradycardia), or the need for intervention such as stimulation or resuscitation. This diagnosis should be assigned when central events are the predominant finding, even if obstructive or mixed apnoeas or hypopneas are also present. Note: A definitive diagnosis requires objective evidence based on polysomnography or alternative monitoring such as hospital or home monitoring. [1]

• 7A40.2 Primary central sleep apnoea of prematurity

  Primary central sleep apnoea of prematurity is characterised by prolonged (> 20 seconds), predominantly central apnoeas or periodic breathing during more than 5% of total sleep time in an infant of less than 37 weeks conceptional age. These events are typically associated with physiological compromise (hypoxemia, bradycardia), or the need for intervention such as stimulation or resuscitation. This diagnosis should be assigned when central events are the predominant finding, even if obstructive or mixed apnoeas or hypopneas are also present. Note: A definitive diagnosis requires objective evidence based on polysomnography or alternative monitoring such as hospital or home monitoring. [1]

• 7A40.3 Central sleep apnea with Cheyne-Stokes breathing

  Central sleep apnoea with Cheyne-Stokes breathing is characterised by recurrent, predominantly central apnoeas or central hypopneas (more than five per hour) alternating with a respiratory phase exhibiting a crescendo-decrescendo pattern of flow (or tidal volume). The longer cycle length (> 40 seconds) distinguishes central sleep apnoea with Cheyne-Stokes breathing from other central sleep apnoea types. The vast majority of patients with Central sleep apnoea with Cheyne-Stokes breathing have either systolic or diastolic heart failure. Patients with Central sleep apnoea with Cheyne-Stokes breathing have normal or low daytime arterial partial pressure of carbon dioxide (PaCO2). The disturbance is typically associated with atrial fibrillation/flutter, congestive heart failure, or a neurological disorder and is sufficiently severe to cause symptoms such as daytime sleepiness, disturbed sleep, awakening with dyspnoea, or snoring. Note: A definitive diagnosis requires objective evidence based on polysomnography. [1]

• 7A40.4 Central sleep apnoea due to a medical condition without Cheyne-Stokes breathing

  Central sleep apnoea due to a medical condition without Cheyne-Stokes breathing (CSB) is characterised by recurrent, predominantly central apnoeas or central hypopneas (more than five per hour) that are attributed to a medical condition (and do not have the pattern of CSB). The majority of these patients have brainstem lesions of developmental, vascular, neoplastic, degenerative, demyelinating, or traumatic origin. The disturbance is sufficiently severe to cause symptoms such as daytime sleepiness, disturbed sleep, awakening with dyspnea, or snoring. Note: A definitive diagnosis requires objective evidence based on polysomnography in the presence of a medical condition that is judged to be causing the symptoms. [1]

• 7A40.5 Central sleep apnoea due to high-altitude periodic breathing

  High-altitude periodic breathing is characterised by alternating periods of central apnoea and hyperpnoea associated with recent ascent to high altitude (typically > 2500 meters). The pattern of periodic breathing is an expected response to ascent to elevation. The disturbance is sufficiently severe to cause symptoms such as daytime sleepiness, disturbed sleep, awakening with dyspnoea, or snoring. The cycle length of this respiratory pattern is commonly less than 40 seconds and often as short as 12 to 20 seconds. Note: This diagnosis can be made clinically based on symptoms and recent ascent to high altitude. [1]

• 7A40.6 Central sleep apnoea due to a medication or substance

  Central sleep apnoea due to a medication is characterised by a pattern of recurring, predominantly central sleep apnoea or hypopnoea (more than five per hour) that is attributable to a medication or substance, most commonly long-acting opioids (e.g. methadone, long-acting morphine or oxycodone, fentanyl patches). The disturbance is sufficiently severe to cause symptoms such as daytime sleepiness, disturbed sleep, awakening with dyspnoea, or snoring. Obstructive apnoeas and hypoventilation may be present, but central sleep apnoea is the predominant finding. Note: A definitive diagnosis requires objective evidence based on polysomnography in the context of medication or substance use that is judged to be causing the symptoms. [1]

• 7A40.7 Treatment-emergent central sleep apnoea

  Treatment-emergent central sleep apnoea is characterised by persistence or emergence of recurrent, predominantly central sleep apnoea (more than five per hour) during effective treatment for obstructive apnoea (obstructive or mixed apnoea or hypopnea) with positive airway pressure. Central apnoeas must be the predominant finding (>50% of total respiratory events). The disturbance is sufficiently severe to cause symptoms such as daytime sleepiness, disturbed sleep, awakening with dyspnea, or snoring. If the reduction or cessation of airflow due to absent or reduced respiratory effort is better explained by another central sleep apnoea disorder (e.g., Central sleep apnoea due to a medication or substance), that diagnosis along with a diagnosis of Obstructive sleep apnoea should be given, rather than a diagnosis of treatment-emergent central sleep apnoea. Note: A definitive diagnosis requires objective evidence based on polysomnography. [1]

Coded elsewhere

• Central neonatal apnoea (KB2A.0)

References

1. World Health Organization. International Classification of Diseases, 11th Revision, for Mortality and Morbidity Statistics (ICD-11 MMS), 2026-01 release. World Health Organization; 2026.

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