Season 7 | Episode 9
Dr. Vaishnavi Kundel, Rami N. Khayat, MD, Dr. Aneesa Das| GUESTS
In this episode, Dr. Seema Khosla examines the complexities of central sleep apnea (CSA) with sleep medicine experts Dr. Vaishnavi Kundel, Dr. Rami N. Khayat, and Dr. Aneesa Das. The discussion moves beyond basic definitions to explore the critical limitations of home sleep apnea testing in accurately detecting CSA and when in-lab polysomnography becomes essential.
The conversation addresses important clinical distinctions between post-arousal, transitional, and mixed apneas, challenging common assumptions about their significance and treatment approaches. The panel provides clarity on various CSA etiologies, including heart failure-related periodic breathing, medication-induced central apneas, treatment-emergent CSA, and neurological disorders.
Discover evidence-based perspectives on treatment strategies, including updated views on adaptive servo-ventilation since the SERVE-HF trial, indications for phrenic nerve stimulation, and the potential of combination therapies. Learn when to consider alternative approaches like dead-space ventilation, supplemental oxygen, and acetazolamide, either alone or as part of hybrid treatment plans.
The discussion also examines practical clinical questions: Does distinguishing between obstructive and central apnea matter if treatment approaches overlap? When should patients with suspected CSA undergo in-lab studies versus home testing? What guidance should clinicians follow for patients with ejection fractions below 45%? Whether you’re managing complex sleep disorders or encountering CSA in primary care, this episode provides essential insights for optimizing patient outcomes through accurate diagnosis and appropriate treatment selection.
Dr. Vaishnavi Kundel
Dr. Vaishnavi Kundel is Associate Professor of Medicine, and Program Director of the Sleep Medicine Fellowship in the Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai in New York City. She completed her training in Internal Medicine at Emory University in Atlanta, and went on to complete her Pulmonary, Critical Care and Sleep Medicine Fellowships at Mount Sinai. As a physician-scientist, her research focuses on exploring the link between sleep apnea and cardiovascular disease using advanced imaging. She has been the recipient of several awards, including the American Thoracic Society ASPIRE Fellowship Award, as well as the American Academy of Sleep Medicine (AASM) Physician-Scientist Training Award. She currently holds an NHLBI K23 Career Development Grant, and the AASM Bridge Award for Early Career Investigators. She is also actively involved in several national and international professional societies, including the American Academy of Sleep Medicine (AASM) and the American Thoracic Society (ATS).
Rami N. Khayat, MD
Rami N. Khayat, MD is currently the division chief of pulmonary and critical care and director of sleep medicine at Penn State University. He has expertise in central sleep apnea treatment especially in patients with heart failure. He has published research on therapies including ASV and phrenic nerve stimulation and outcomes of CSA in HF.
Dr. Aneesa Das
Dr. Aneesa Das is a professor in the division of pulmonary, critical care and sleep at The Ohio State University. She is the director of the home sleep apnea testing program and assistant director of the sleep disorders program. She currently serves on the Board of Regents for CHEST. Dr. Das earned her medical degree from the University of Virginia School of Medicine in Charlottesville and completed her training at University of North Carolina Healthcare in Chapel Hill. She is board-certified in pulmonary disease and sleep medicine.
Resources
- Kundel V, Ahn A, Arzt M, Asin J, Azarbarzin A, Collop N, Das A, Fang JC, Khayat R, Penzel T, Pépin JL, Sharma S, Suurna MV, Tallavajhula S, Malhotra A. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. J Clin Sleep Med. 2025 Feb 1;21(2):405-416. https://doi.org/10.5664/jcsm.11424
