Cheyne-Stokes breathing

Cheyne-Stokes respiration (CSR) is a pattern of breathing characterized by a gradual increase in the depth and sometimes speed of breaths followed by a decrease, resulting in a temporary stop in breathing called an apnea. This pattern repeats cyclically. Named after John Cheyne and William Stokes, the 19th-century physicians who first described it, Cheyne-Stokes respiration is often associated with severe illness, particularly heart failure, but can also be seen in cases of stroke, brain injury, and in high-altitude settings. It is considered a form of central sleep apnea.

Causes and Pathophysiology

Cheyne-Stokes respiration is primarily caused by decreased blood flow to the brain, leading to impaired carbon dioxide sensitivity. In heart failure, for example, reduced cardiac output leads to decreased cerebral perfusion, which can trigger the abnormal breathing pattern. The exact mechanism involves fluctuations in the control of breathing by the brain, where the body overcompensates for high carbon dioxide levels by breathing faster and deeper, and then undercompensates as the carbon dioxide levels fall, leading to apnea.

Clinical Presentation

Patients with Cheyne-Stokes respiration exhibit a distinctive pattern of breathing that starts with shallow breaths that gradually increase in depth and frequency before decreasing and leading to a period of no breathing. This cycle typically lasts from 30 seconds to 2 minutes. It is most commonly observed during sleep but can also occur in awake patients in severe cases.

Diagnosis

Diagnosis of Cheyne-Stokes respiration involves a clinical examination and the use of sleep study tests such as polysomnography, which records the breathing patterns, blood oxygen levels, and brain activity during sleep. A detailed medical history, especially concerning underlying conditions like heart failure or stroke, is also crucial for diagnosis.

Treatment

Treatment of Cheyne-Stokes respiration focuses on managing the underlying condition. In patients with heart failure, optimizing heart function can reduce the occurrence of CSR. Additional treatments may include the use of Continuous Positive Airway Pressure (CPAP) or Adaptive Servo-Ventilation (ASV), especially for those with concurrent sleep apnea. Oxygen therapy and medications to stabilize breathing patterns may also be beneficial.

Prognosis

The prognosis for patients with Cheyne-Stokes respiration varies depending on the underlying cause. While the breathing pattern itself is not life-threatening, it can be a marker of severe underlying diseases, which can significantly impact the overall prognosis.

See Also

• Sleep apnea
• Respiratory failure
• Heart failure