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Acute central respiratory depression is a form of respiratory failure. Respiratory failure is defined as impairment of gas exchange between ambient air and circulating blood: problems in intrapulmonary gas exchange lead to hypoxemia and problems in the movement of gases cause hypercapnia. Depression of the respiratory center with resulting respiratory acidosis may occur: acutely with general anesthetics, sedatives, and head trauma, or chronically with sedatives, alcohol, intracranial tumors, and syndromes of sleep-disordered breathing, including the primary alveolar and obesity-hypoventilation syndromes. Acute hypoxemia may cause cardiac arrhythmia and coma. Alteration of consciousness is typical, confusion is common. Acute hypercapnia may cause: subtle personality changes and headache through to marked confusion and narcosis, cerebral vasodilation and increased CSF pressure, acidemia which, when severe, contributes to pulmonary arteriolar vasoconstriction, systemic vascular dilation, reduced myocardial contractility, hyperkalemia, hypotension, and cardiac irritability. Central respiratory depression mainly occurs in neonates of prematurity or in sleep apnea. Apnea of prematurity may be caused by CNS immaturity (central) or airway obstruction. Central sleep apnea (CSA) has two categories: 1. Hypercapnia with decreased ventilatory drive or a decreased ability to breathe. 2. Eucapnia or hypocapnia with increased ventilatory drive but sleep-induced apnea and periodic breathing. Cheyne-Stokes breathing is a discrete pattern of this form of CSA that may be seen in opiate associated respiratory depression.
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