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Central Sleep Apnea vs Obstructive Sleep Apnea

Table of Contents

Some people mistakenly believe all types of sleep apnea are alike. In truth, there are two primary types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). While a physical airway collapse causes obstructive sleep apnea, central sleep apnea is a brain-driven problem with the breathing control centre. 

Obstructive sleep apnea occurs when the tissues of the nose, soft palate, tongue base or epiglottis narrow the airway during sleep, blocking airflow and causing loud snoring or gasping. 

Central sleep apnea occurs when the brain’s respiratory control system becomes unstable, leading to breathing pauses or shallow breathing despite an open airway. During a CSA, the person may stop breathing completely for several seconds.

Understanding the differences between obstructive and central sleep apnea, including the detection of obstructive and central apnea events and the role of respiratory effort, is the first step toward choosing the appropriate test and therapy.

Causes and Risk Factors

The causes and risk factors for sleep apnea depend on the type of sleep disorder.

Obstructive sleep apnea is most commonly linked to excess body weight, large neck circumference and anatomical factors that contribute to upper airway obstruction. Health conditions such as hypertension and diabetes can also increase the risk of developing obstructive sleep apnea.

Central sleep apnea is often associated with underlying medical issues like heart failure, neurological disorders and high altitude.

Additional risk factors for both types of sleep apnea include older age, male sex, family history and lifestyle habits such as smoking and alcohol use.

Knowing these risk factors is key to preventing and treating sleep apnea. Simple changes like losing weight, avoiding sleeping on your back, and managing chronic health conditions can reduce the risk of obstructive sleep apnea and improve overall sleep health.

obstructive sleep apnea causes

What Are the Symptoms?

Both apneas disturb sleep and daytime function, but OSA is noisy, and CSA is quiet and subtle. People with OSA snore loudly, choke or gasp at night, wake with a dry mouth and morning headaches and feel unrefreshed despite a whole night in bed. Partners may witness pauses that end with a snort.

Central sleep apnea symptoms can mimic those of obstructive sleep apnea, making diagnosis challenging for healthcare providers. CSA may present with quiet pauses, fragmented sleep and breathlessness out of proportion to snoring, which can lead to insomnia-like complaints. Daytime effects overlap and include fatigue, reduced focus, irritability and low mood. Some patients have mixed apneas, in which both central and obstructive events appear.

central sleep apnea vs obstructive sleep apnea symptoms

When to See an ENT Specialist

See an ENT specialist if you snore, stop breathing during sleep, or have nasal congestion or a crowded throat.

You should also book an evaluation if you have high blood pressure that is hard to control, atrial fibrillation, Type 2 diabetes or daytime sleepiness that affects driving and work. It’s essential to assess underlying sleep apnea to ensure the root cause of your symptoms is identified and the most appropriate treatment is provided. An experienced ENT, such as Dr Barrie Tan, will examine your upper airway, coordinate appropriate sleep testing, and initiate evidence-based therapy promptly to reduce health risks.

Diagnosis of Central and Obstructive Sleep Apnea

Diagnosis combines history, targeted examination and sleep testing to separate type and severity. Your visit begins with a focused discussion of sleep patterns, nasal breathing, jaw position and throat anatomy, followed by a careful head and neck exam.

Sleep testing uses either a home sleep test or in-lab polysomnography to confirm the diagnosis and grade severity. The apnea hypopnea index (AHI) is calculated during these studies to classify the severity of obstructive sleep apnea, with an AHI of:

  • 5-15 events per hour indicates mild sleep apnea
  • 15-30 events per hour indicates moderate sleep apnea
  • 30 or more events per hour indicates severe sleep apnea


When surgery is considered for OSA, drug-induced sleep endoscopy can map the exact level of airway collapse so treatment can be precise rather than speculative. This structured approach clarifies the distinction between central sleep apnea and obstructive sleep apnea and avoids one-size-fits-all decisions.

central sleep apnea vs obstructive sleep apnea diagnosis
Related: Central Sleep Apnea

Barrie Tan ENT Head & Neck Surgery provides comprehensive care for snoring and all types of sleep apnea.

If you believe you or a loved one has sleep apnea, contact us today so that we can start working on a plan towards better sleep.

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Non-Surgical Management

ENT specialists assess the airway, coordinate sleep testing, optimise CPAP and operate when anatomy blocks airflow. Most patients start with lifestyle changes and positive airway pressure matched to their exact diagnosis. Weight loss, side sleeping and limiting evening alcohol further reduce airway collapse. ENT specialists are also trained to diagnose and manage a range of sleep disorders, not just sleep apnea.

 

Obstructive Sleep Apnea

OSA evaluation starts with a focused history and exam, followed by a home sleep test or in-lab polysomnography to confirm severity and guide therapy. Continuous Positive Airway Pressure (CPAP) remains a first-line therapy that delivers a steady, gentle airflow through a mask to keep the airway open overnight. Settings are adjusted during follow-up, and comfort features like heated humidification help with adaptation. First-time users may also use a ramp, a timed setting that gradually adjusts pressure to ease use. Mask choices include nasal pillows, nasal masks and full-face options. Typical side effects such as dryness, mild bloating, or skin marks are usually resolved with a better fit, humidification, or minor setting tweaks.

If CPAP is difficult, a custom mandibular advancement device, arranged with trusted dental partners, can be effective. To pinpoint the blockage, drug-induced sleep endoscopy will reveal whether the collapse occurs at the nose, palate, tongue base, epiglottis, or a combination of these, preventing unnecessary procedures. When surgery is needed, the plan is tailored to your condition.

For OSA, procedures are chosen based on the site of collapse identified during evaluation or a drug-induced sleep endoscopy. Options include full OSA surgery, including septoplasty and turbinate reduction to improve nasal breathing; tonsillectomy and uvulopalatopharyngoplasty (UPPP) to widen the palate; tongue base or epiglottis surgery, including transoral robotic techniques in the right candidate; and maxillomandibular advancement with oral and maxillofacial surgeons. Hypoglossal nerve stimulation implants may be used to provide a pacemaker-like approach to tongue tone for carefully screened patients who cannot tolerate CPAP.

 

obstructive sleep apnea treatment

 

Central Sleep Apnea

Central sleep apnea care begins by addressing the underlying cause. That may include optimising heart failure therapy, reviewing opioids and other sedating medicines and addressing altitude exposure.

CPAP may help several CSA subtypes:

  1. Bilevel Positive Airway Pressure with a backup rate (BPAP-ST) is more widely used for primary CSA, medication-related CSA, treatment-emergent CSA, and CSA linked to other medical conditions.
  2. Adaptive servo-ventilation (ASV) stabilises breathing in complex patterns, while low-flow oxygen or acetazolamide support specific triggers. Your ENT specialist will improve nasal airflow through allergy control or minor procedures to boost mask tolerance, coordinating with sleep physicians for seamless care.

 

For CSA, there are no surgical options. Management is device-based, and medical therapy with phrenic nerve stimulation is considered by sleep and cardiology teams when other options fail.

 

central sleep apnea treatment

 

Complex Sleep Apnea Syndrome

Complex sleep apnea syndrome is a condition in which a person experiences both obstructive and central sleep apnea on the same night. The combination of airway obstruction and breathing control disruption makes complex sleep apnea harder to diagnose and manage.

Treatment for complex sleep apnea syndrome often requires a multifaceted approach, including CPAP to keep the airway open and adjustments to address the central component. In some cases, advanced positive airway pressure devices or medications may be needed. Working with a sleep specialist is crucial to developing a personalised plan that addresses both the obstructive and central aspects of the condition. Significantly, complex sleep apnea increases the risk of cardiovascular disease, underscoring the need for management to support long-term health and quality of life.

 

Risks and Surgical Recovery

Risks depend on the therapy, and recovery time ranges from days to weeks. Nasal surgery results in a few days of congestion and mild discomfort. Tonsil and palate surgery has a longer recovery with throat pain, diet changes and small risks of bleeding or voice alteration. Tongue base work can cause temporary swelling and speech changes.

Maxillomandibular advancement has a more extended recovery period with facial swelling, but it can be life-changing if the root cause of the sleep apnea is anatomical. Hypoglossal nerve stimulation requires a short operation with healing before device programming. Any surgical plan includes follow-up sleep testing to document results.

For CSA and OSA device therapies, there is an acclimatisation period, during which attention to mask fit and periodic adjustment of settings are vital to maintaining stable breathing and restorative sleep. Improper mask fit or incorrect device settings can result in insufficient air reaching the lungs, requiring further adjustment to ensure effective therapy.

 

CSA and OSA surgery

 

Book a Sleep Apnea Consultation

If you are trying to figure out if you have central sleep apnea vs obstructive sleep apnea and want a clear plan, book a consultation with Barrie Tan ENT Head and Neck Surgery at Gleneagles Hospital in Singapore. We will confirm your diagnosis, personalise treatment and help you sleep soundly again.

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Frequently Asked Questions about CSA & OSA

Untreated obstructive or central sleep apnea worsens daytime sleepiness. It is linked to higher risks of high blood pressure, heart rhythm problems, insulin resistance, accidents, heart disease, and a reduced quality of life. Getting treated usually improves energy, mood and long-term mental and physical health.
A home sleep test or in-lab polysomnography measures airflow and breathing effort. Obstructive events show airflow obstruction despite ongoing effort. Central events show reduced or absent effort despite an open airway. Sleep studies are interpreted by specialists who are trained to distinguish between these patterns.
Obstructive sleep apnea is usually loud with snoring, gasping and choking. Central sleep apnea is quieter with subtle pauses, fragmented sleep and insomnia-like complaints, especially in people with heart or neurologic conditions.
Can I have both at the same time?
Both apneas are risky in different ways. OSA is linked to hypertension and atrial fibrillation. CSA is linked to heart failure. Treating CSA vs OSA reduces symptoms and improves long-term heart health.

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At Barrie Tan ENT Head & Neck Surgery, we are committed to providing compassionate and comprehensive care to help our patients regain their hearing and restore optimal ENT health.