Central sleep apnoea (CSA) is a complex condition with multiple phenotypes, each characterized by distinct underlying causes, pathophysiological mechanisms, and treatment responses. The article discusses the heterogeneity of CSA, emphasizing the importance of phenotyping for individualized treatment. Key phenotypes include hypercapnic and nonhypercapnic CSA, as well as CSA associated with chronic heart failure (CHF), stroke, medications, and other medical conditions. The article highlights the role of loop gain, apnoea threshold, and CO₂ reserve in CSA pathophysiology. It also addresses the challenges in diagnosing and differentiating CSA from obstructive sleep apnoea (OSA), noting the variability in CSA severity across nights and the need for longitudinal studies. The article reviews the current understanding of adaptive servo-ventilation (ASV) and its role in CSA treatment, as well as the prognostic significance of CSA in CHF and other conditions. Treatment options include positive airway pressure (PAP), noninvasive ventilation, and pharmacological agents. The article also discusses the limitations of current definitions and the need for further research to refine CSA classification and improve treatment outcomes.Central sleep apnoea (CSA) is a complex condition with multiple phenotypes, each characterized by distinct underlying causes, pathophysiological mechanisms, and treatment responses. The article discusses the heterogeneity of CSA, emphasizing the importance of phenotyping for individualized treatment. Key phenotypes include hypercapnic and nonhypercapnic CSA, as well as CSA associated with chronic heart failure (CHF), stroke, medications, and other medical conditions. The article highlights the role of loop gain, apnoea threshold, and CO₂ reserve in CSA pathophysiology. It also addresses the challenges in diagnosing and differentiating CSA from obstructive sleep apnoea (OSA), noting the variability in CSA severity across nights and the need for longitudinal studies. The article reviews the current understanding of adaptive servo-ventilation (ASV) and its role in CSA treatment, as well as the prognostic significance of CSA in CHF and other conditions. Treatment options include positive airway pressure (PAP), noninvasive ventilation, and pharmacological agents. The article also discusses the limitations of current definitions and the need for further research to refine CSA classification and improve treatment outcomes.