Introduction
The prevalence of central apneas affect approximately 4-6% of children,
although the prevalence might be higher than
expected1–3. In children, central apnea is defined as
a reduction in airflow by at least 90%, accompanied by the absence of
respiratory effort lasting more than 20 seconds, or more than 2
respiratory efforts coupled with a reduction in oxygen saturation
(SaO2) of at least 3% and/or arousals and/or
bradycardia in infants4. The Central Apnea Index
(cAHI) reflects the number of central apneas per hour of sleep. cAHI
observed during polysomnography (PSG) is considered significant when ≥ 1
event/hour; indicating clinical relevance, and indicative of severe
pathology when ≥ 52,4,5events/hour. Nevertheless, cAHI
values between 1 and 5 can be associated with significant desaturations
and/or prolonged cycles of periodic breathing
(PB)6–8. PB entails the occurrence of at least 3
central apneas lasting at least 3 seconds interspersed with period of
normal breathing, each lasting less than 20
seconds4,6,9,10. Typically, central apneas and PB, if
not excessively represented and not associated with significant
desaturations, are considered normal during infancy due to the
physiological immaturity of the respiratory centers. With the maturation
of the respiratory centers beyond the first year of life, central apnea
events become infrequent. However, there are various clinical conditions
in which patients may present with pathological central apneas and/or
PB. Such conditions encompass idiopathic central apnea syndrome, central
hypoventilation syndromes, instances involving heart diseases,
Prader-Willi syndrome, Down syndrome, achondroplasia, and various
neurological conditions such as Arnold-Chiari malformation and
encephalopathy and/or epilepsy11. Additionally,
central apneas can also manifest within the context of obstructive
apneas, likely stemming from
hyperrventilation2,12–21. Therapeutic options for
central apneas remain relatively underexplored and sparsely documented
in the literature so far5–7. Usually, non-invasive
ventilation (NIV) is the preferred therapeutic approach for clinically
relevant central apneas. Despite this, in the literature, very little is
known about central apneas and exists limited evidence concerning the
optimal ventilatory strategy. Therefore, the objective of our study was
to conduct a retrospective evaluation over the past 10 years (2012-2022)
of all patients with central apneas who underwent ventilation at the
Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù
Children’s Hospital in Rome. Our assessment encompassed identifying the
type of pathology, poly(somno)graphic parameters, the chosen ventilatory
approach and its effectiveness.