Central sleep apnea treated by a constant low-dose CO2 supplied by a novel device

Yuan Ming Luo, Yong Yi Chen, Shan Feng Liang, Lu Guang Wu, Andrew Wellman, R. Doug McEvoy, Joerg Steier, Danny J. Eckert, Michael I. Polkey

Research output: Contribution to journalArticlepeer-review


CO 2 inhalation has been previously reported as a treatment for central sleep apnea both when associated with heart failure or where the cause is unknown. Here, we evaluated a novel CO 2 supply system using a novel open mask capable of comfortably delivering a constantly inspired fraction of CO 2 (FI CO2) during sleep. We recruited 18 patients with central sleep apnea (13 patients with cardiac disease, and 5 patients idiopathic) diagnosed by diaphragm electromyogram (EMG) recordings made during overnight full polysomnography (PSG) (night 1). In each case, the optimal FI CO2 was determined by an overnight manual titration with PSG (night 2). Titration commenced at 1% CO 2 and increased by 0.2% increments until central sleep apnea (CSA) disappeared. Patients were then treated on the third night (night 3) with the lowest therapeutically effective concentration of CO 2 derived from night 2. Comparing night 1 and night 3, both apnea-hypopnea index (AHI; 31±14 vs. 6±3 events/h, P < 0.01) and arousal index (22±8 vs. 15±8 events/h, P < 0.01) were significantly improved during CO 2 treatment. Sleep efficiency improved from 71±18 to 80±11%, P < 0.05, and sleep latency was shorter (23±18 vs. 10±10 min, P < 0.01). Heart rate was not different between night 1 and night 3. Our data confirm the feasibility of our CO 2 delivery system and indicate that individually titrated CO 2 supplementation with a novel device including a special open mask can reduce sleep disordered breathing severity and improve sleep quality. Randomized controlled studies should now be undertaken to assess therapeutic benefit for patients with CSA.

Original languageEnglish
Pages (from-to)977-984
Number of pages8
JournalJournal of Applied Physiology
Issue number5
Publication statusPublished - Nov 2023


  • central sleep apnea
  • CO2 inhalation
  • heart failure
  • novel device


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