Cheyne-Stokes respiration

Cheyne-Stokes Respiration

Cheyne-Stokes respiration is a distinct pattern of breathing characterized by a gradual increase in the depth and sometimes the rate of breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. This cycle then repeats itself. It is named after John Cheyne and William Stokes, who first described the condition in the 19th century.

Pathophysiology

Cheyne-Stokes respiration is often associated with heart failure, stroke, brain injury, and other conditions that affect the central nervous system. The pattern is thought to result from a delay in the feedback loop between the brain and the respiratory system. This delay causes an overcompensation in the control of breathing, leading to the characteristic waxing and waning pattern.

The cycle begins with hyperventilation, which reduces the level of carbon dioxide in the blood. As the carbon dioxide level falls, the drive to breathe decreases, leading to hypoventilation or apnea. As carbon dioxide accumulates again, the drive to breathe increases, restarting the cycle.

Clinical Significance

Cheyne-Stokes respiration is often observed in patients with severe congestive heart failure and can be a sign of poor prognosis. It is also seen in patients with central sleep apnea, where the brain intermittently fails to send signals to the muscles that control breathing.

In the context of heart failure, Cheyne-Stokes respiration can lead to poor sleep quality, increased sympathetic nervous system activity, and worsening of heart failure symptoms. It is important for clinicians to recognize this pattern and consider it in the management of affected patients.

Diagnosis

Diagnosis of Cheyne-Stokes respiration typically involves a polysomnography test, which records various physiological parameters during sleep. This test can help differentiate Cheyne-Stokes respiration from other types of sleep-disordered breathing, such as obstructive sleep apnea.

Treatment

Treatment of Cheyne-Stokes respiration focuses on addressing the underlying condition, such as optimizing heart failure management. In some cases, supplemental oxygen or positive airway pressure therapy may be used to stabilize breathing patterns. Adaptive servo-ventilation (ASV) is a specific type of positive airway pressure therapy that can be effective in treating Cheyne-Stokes respiration in certain patients.

History

The condition was first described by John Cheyne, a Scottish physician, in 1818, and later by William Stokes, an Irish physician, in 1854. Their observations laid the foundation for understanding this unique respiratory pattern.

Also see

• Sleep apnea
• Heart failure
• Central nervous system
• Polysomnography