Cheyne Stokes respiration

Cheyne-Stokes Respiration
Specialty	Pulmonology
Symptoms	Cyclic pattern of breathing with periods of apnea
Causes	Heart failure, stroke, brain injury
Diagnostic method	Clinical observation, polysomnography
Treatment	Treat underlying cause, oxygen therapy, CPAP

Cheyne-Stokes respiration is a distinct pattern of breathing characterized by a cyclical fluctuation between periods of deep, rapid breathing and periods of apnea, where breathing temporarily stops. This condition is named after John Cheyne and William Stokes, who first described it in the 19th century.

Pathophysiology

Cheyne-Stokes respiration is often associated with heart failure, stroke, and brain injury. The underlying mechanism involves a delay in the feedback loop between the brain's respiratory centers and the lungs. This delay causes an oscillation in the levels of carbon dioxide and oxygen in the blood, leading to the characteristic waxing and waning pattern of breathing.

During the hyperventilation phase, the patient breathes deeply and rapidly, which reduces the carbon dioxide levels in the blood. This is followed by a period of apnea, where breathing stops, allowing carbon dioxide levels to rise again. The cycle then repeats.

Clinical Presentation

Patients with Cheyne-Stokes respiration may experience disrupted sleep, excessive daytime sleepiness, and fatigue. The condition is often observed during sleep, particularly in patients with congestive heart failure or central sleep apnea.

Diagnosis

Diagnosis of Cheyne-Stokes respiration is primarily clinical, based on the observation of the characteristic breathing pattern. However, polysomnography can be used to confirm the diagnosis and assess the severity of the condition. This sleep study records various physiological parameters during sleep, including respiratory effort, airflow, and blood oxygen levels.

Treatment

The management of Cheyne-Stokes respiration focuses on treating the underlying condition. In patients with heart failure, optimizing heart function through medications such as ACE inhibitors, beta-blockers, and diuretics can improve symptoms.

For patients with central sleep apnea, continuous positive airway pressure (CPAP) therapy may be beneficial. Supplemental oxygen therapy can also help maintain adequate oxygen levels during sleep.

Prognosis

The prognosis of Cheyne-Stokes respiration depends on the underlying cause. In patients with heart failure, the presence of Cheyne-Stokes respiration is associated with a poorer prognosis and increased mortality. Effective management of the underlying condition can improve outcomes.

Also see

• Sleep apnea
• Heart failure
• Central sleep apnea
• Polysomnography