Children's Hospital Colorado

Central Sleep Apnea (CSA)

What is Central Sleep Apnea?

Central sleep apnea (CSA) is a pause in breathing during sleep, usually without snoring or gasping. Everyone experiences central apneas occasionally. However, if it occurs too frequently or for long periods of time, it can cause a decrease in the oxygen levels in the body and disrupt sleep.

What causes CSA?

Central Sleep Apnea occurs when the part of the brain that controls breathing restarts the inhalation and exhalation breathing process after a small delay in time. All people living at high altitude have central apnea normally, and the higher you go, the more apnea is likely. This occurs because altitude stimulates fast breathing to raise oxygen, which blows off carbon dioxide. This signals the brain to stop breathing for a pause, then the cycle returns.

Central apnea can occur in premature babies since the breathing center in the brain is not mature. Neurological disorders can also contribute to CSA. These include brain injuries, brain masses, Chiari malformations and certain medications that suppress the breathing. Narcotics and opiate medications, even at low doses, are well known to cause central apnea.

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What are the signs and symptoms of CSA?

  • Observed episodes of pauses in breathing or abnormal breathing patterns during sleep
  • Abrupt awakenings followed by shortness of breath
  • Frequent awakenings in general
  • Headaches in the morning
  • Difficulty focusing and concentrating
  • Daytime sleepiness (if sleep is disturbed)

What tests are used to diagnose CSA?

An overnight sleep study, also called a Polysomnogram (PSG), is the best way to diagnose CSA and needs to be ordered by a medical provider. During the sleep study, the child’s breathing is monitored closely in order to capture any signs of sleep disordered breathing.

How is CSA treated?

A baby wearing a black and white striped shirt has a breathing mask strapped to his head while a parent holds him and a doctor's hand supports the mask.

Your doctor will recommend treatments depending on the specific cause of your child's CSA. If prematurity is the cause, supplemental oxygen is often the treatment until the child's breathing matures. A second sleep study is often done as the child grows to reassess breathing and to make sure the child is outgrowing CSA.

For children who have neurological problems causing the CSA, the treatment is often to assist breathing at night with oxygen. Continuous positive airway pressure (CPAP) or Bi-level positive air pressure (PAP) therapy can help a child regulate their breathing, by delivering air pressure through a nasal mask while they are sleeping.

Some children have trouble learning to wear a mask all night. Those children may need assistance to tolerate PAP therapy. We have a desensitization program for these patients to help them learn to sleep with PAP therapy.

Why choose Children's Hospital Colorado for your child's CSA?

The Children's Hospital Colorado Sleep Team is an excellent resource for treating children and adolescent with CSA. Or providers are known internationally for their expertise in sleep research and sleep treatments. The team is made up of sleep specialists trained in different aspects of sleep treatments, including:

  • Sleep physicians who specialize in children's breathing issues and children's ear-nose-and throat problems
  • A sleep-specialized psychologist
  • Two sleep-specialized nurse practitioners
  • A sleep-specialized respiratory therapist
  • A dedicated sleep nurse

We often coordinate care with other specialists, like neurologists, and primary care physicians involved in each family's treatment. Most importantly, we have very caring staff members who are willing to listen to families and "go the extra mile" to improve sleep and optimize development.


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