What is sleep-related hypoventilation?

Updated: Oct 09, 2018
  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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In sleep-related hypoventilation, PSG demonstrates episodes of decreased respiration associated with elevated levels of carbon dioxide. In the absence of objective measures of carbon dioxide, persistent low levels of hemoglobin oxygen saturation dissociated from apneic/hypopneic events are also indicative. DSM-5 specifies that in order make this diagnosis, the condition is not better explained by another sleep disorder. In DSM-5, the 3 subtypes are idiopathic hypoventilation, congenital central alveolar hypoventilation, and comorbid sleep-related hypoventilation

Individuals with sleep-related hypoventilation may present with insomnia/sleepiness and/or headaches upon awakening. This disorder can coexist with obstructive sleep apnea hypopnea and central sleep apnea. Patients may have diaphragmatic weakness or ventilatory insufficiency resulting from pulmonary hypertension, cor pulmonale (right-sided heart failure), polycythemia, or neurocognitive dysfunction. Episodes of hypoventilation may be associated with frequent arousals or bradytachycardia. Hypoventilation cannot be present during wakefulness. Other causes of sleep-related hypoventilation include chronic obstructive pulmonary disease (COPD), neuromuscular disorders, and obesity.

Idiopathic and congenital central alveolar hypoventilation are extremely rare. Congenital central alveolar hypoventilation occurs in association with autonomic dysfunction or Hirschsprung disease. Some cases of idiopathic hypoventilation may be cases of late-onset congenital central alveolar hypoventilation.

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