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.