A 62-year-old man with dilated cardiomyopathy and left ventricular ejection fraction of 30% reports fragmented sleep and witnessed pauses in breathing. Polysomnography shows repeated episodes of apnoea in which airflow ceases AND there is complete absence of thoracoabdominal respiratory effort, occurring in a crescendo-decrescendo pattern. What is the most likely diagnosis?

• A Obstructive sleep apnoea
• B Upper airway resistance syndrome
• C Central sleep apnoea with Cheyne-Stokes respiration ✓
• D Sleep-related hypoventilation

Explanation

Central sleep apnoea is defined by cessation of airflow WITH absence of respiratory effort, reflecting failure of ventilatory drive rather than airway occlusion. In systolic heart failure it takes the Cheyne-Stokes pattern of waxing and waning ventilation. Obstructive apnoea shows persistent or increased respiratory effort against a closed airway, which is the finding that excludes option A.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.