Have you ever wondered if your patient pausing to breathe in their sleep is concerning or not? Learn about the signs of central sleep apnea and which medical conditions it is often associated with in pediatric patients in this episode.

This episode was written by pediatricians Tammy Yau, Lidia Park, and Jessica Ahn, with content support from Ambika Chidambaram (UCD pediatric pulmonology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

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Key Points

• Central sleep apnea (CSA) occurs when the brain’s central respiratory drive can’t send proper signals to the muscles that are part of breathing.
• CSA is diagnosed by a polysomnogram if there are apneic episodes that last 20 seconds or longer or if they are associated with oxygen desaturations, arousals, or heart rate changes (specific criteria in footnote).
• Central apneas are considered normal during certain stages of sleep (onset, during REM, after arousal), in premature infants less than 37 weeks corrected gestational age, and when ascending to altitudes greater than 3500 m above sea level.
• Common pediatric conditions associated with CSA include congenital central hypoventilation syndrome, achondroplasia, and Arnold-Chiari malformations. 

Diagnostic Criteria for CSA

• Apneic episodes last 20 seconds or longer OR
• The apnea lasts at least the duration of two breaths during baseline breathing and is associated with an arousal or at least a 3% oxygen desaturation OR
• If the event occurs in an infant younger than 1 years old, it has to last at least the duration of two breaths during baseline breathing AND be associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds OR less than 60 beats per minute for 15 seconds

Diagnostic Criteria for Periodic Breathing

• At least three episodes of central pauses lasting for at least 3 seconds interspersed by less than 20 seconds of normal breathing.

References

• Gipson K, Lu M, Kinane TB. Sleep-Disordered breathing in children. Pediatrics in Review. 2019;40(1):3-13. doi:10.1542/pir.2018-0142
• McLaren AT, Bin-Hasan S, Narang I. Diagnosis, management and pathophysiology of central sleep apnea in children. Paediatric Respiratory Reviews. 2018;30:49-57. doi:10.1016/j.prrv.2018.07.005
• Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Journal of Clinical Sleep Medicine. 2012;08(05):597-619. doi:10.5664/jcsm.2172
• Javaheri S, Dempsey JA. Central sleep apnea. Comprehensive Physiology. Published online December 10, 2012:141-163. doi:10.1002/cphy.c110057
• Selim BJ, Somers V, Caples SM. Central sleep apnea, hypoventilation syndrome, and sleep in high altitude. In: Springer eBooks. ; 2017:597-618. doi:10.1007/978-1-4939-6578-6_33
• Fauroux B, AlSayed M, Ben-Omran T, et al. Management of sleep-disordered breathing in achondroplasia: guiding principles of the European Achondroplasia Forum. Orphanet Journal of Rare Diseases. 2025;20(1). doi:10.1186/s13023-025-03717-0