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In most circumstances, the cyclic absence of effort is paradoxically a consequence of hypersensitive ventilatory chemoreflex responses to oppose changes in airflow, that is elevated loop gain, leading to overshoot\/undershoot ventilatory oscillations. Considerable evidence illustrates overlap between\n                    <jats:styled-content style=\"fixed-case\">CSA<\/jats:styled-content>\n                    and obstructive sleep apnoea (\n                    <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content>\n                    ), including elevated loop gain in patients with\n                    <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content>\n                    and the presence of pharyngeal narrowing during central apnoeas. Indeed, treatment of\n                    <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content>\n                    , whether via continuous positive airway pressure (\n                    <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content>\n                    ), tracheostomy or oral appliances, can reveal\n                    <jats:styled-content style=\"fixed-case\">CSA<\/jats:styled-content>\n                    , an occurrence referred to as complex sleep apnoea. Factors influencing loop gain include increased chemosensitivity (increased controller gain), reduced damping of blood gas levels (increased plant gain) and increased lung to chemoreceptor circulatory delay. Sleep\u2013wake transitions and pharyngeal dilator muscle responses effectively raise the controller gain and therefore also contribute to total loop gain and overall instability. In some circumstances, for example apnoea of infancy and central congenital hypoventilation syndrome, central apnoeas are the consequence of ventilatory depression and defective ventilatory responses, that is low loop gain. The efficacy of available treatments for\n                    <jats:styled-content style=\"fixed-case\">CSA<\/jats:styled-content>\n                    can be explained in terms of their effects on loop gain, for example\n                    <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content>\n                    improves lung volume (plant gain), stimulants reduce the alveolar\u2010inspired\n                    <jats:styled-content style=\"fixed-case\">\n                      PCO\n                      <jats:sub>2<\/jats:sub>\n                    <\/jats:styled-content>\n                    difference and supplemental oxygen lowers chemosensitivity. Understanding the magnitude of loop gain and the mechanisms contributing to instability may facilitate personalized interventions for\n                    <jats:styled-content style=\"fixed-case\">CSA<\/jats:styled-content>\n                    .\n                  <\/jats:p>","DOI":"10.1111\/resp.12927","type":"journal-article","created":{"date-parts":[[2016,10,31]],"date-time":"2016-10-31T07:47:02Z","timestamp":1477900022000},"page":"43-52","source":"Crossref","is-referenced-by-count":136,"title":["Pathogenesis of central and complex sleep apnoea"],"prefix":"10.1111","volume":"22","author":[{"given":"Jeremy E.","family":"Orr","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Sands","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Allergy Immunology and Respiratory Medicine and Central Clinical School The Alfred and Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,31]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1542\/peds.84.5.785","article-title":"Periodic breathing in preterm infants: incidence and characteristics","volume":"84","author":"Glotzbach SF","year":"1989","journal-title":"Pediatrics"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1986.61.1.280"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5664\/jcsm.27076","article-title":"The current prevalence of sleep disordered breathing in congestive heart failure patients treated with beta\u2010blockers","volume":"4","author":"MacDonald M","year":"2008","journal-title":"J. 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