Who Is At Risk Of Cheyne-Stokes Breathing?

Cheyne-Stokes respiration is an abnormal breathing pattern characterised by cyclical episodes of apnea and hyperventilation. It is caused by damage to respiratory centres or physiological abnormalities in congestive heart failure. It is also seen in newborns with immature respiratory systems, in visitors new to high altitudes, and in severely ill patients approaching end-of-life. Cheyne-Stokes respiration is associated with heart failure, strokes, hyponatremia, traumatic brain injuries, and brain tumours. Up to 20% of patients with strokes can exhibit Cheyne-Stokes respiration.

Cheyne-Stokes respiration is a type of breathing disorder

Cheyne-Stokes respiration is an abnormal breathing pattern that commonly occurs in patients with decompensated congestive heart failure and neurological diseases. It is characterised by progressively deeper, and sometimes faster, breathing followed by a gradual decrease until breathing stops temporarily. Each cycle usually lasts between 30 seconds and 2 minutes and repeats. It is associated with changing serum partial pressures of oxygen and carbon dioxide.

Cheyne-Stokes respiration is often associated with:

• Heart failure
• Strokes
• Hyponatremia
• Traumatic brain injuries
• Brain tumours
• High-altitude sickness
• Kidney failure
• Narcotic poisoning
• Intracranial pressure
• Hypoperfusion of the brain

The true prevalence of Cheyne-Stokes respiration in the general population is unknown and is considered rare. However, due to varied definitions and detection methods, the incidence in patients with heart failure ranges from 25% to 50%. This means that out of nearly 5.7 million patients with heart failure, 2 to 3 million are expected to experience Cheyne-Stokes respiration.

The clinical features of Cheyne-Stokes respiration are similar to those of congestive heart failure and include dyspnea, cough, and fatigue. Patients with Cheyne-Stokes respiration and heart failure exhibit more lethargy and fatigue due to increased sympathetic activity caused by disturbed sleep.

The main focus of Cheyne-Stokes respiration management is optimising the treatment of the underlying cause, such as congestive heart failure or stroke. Positive airway pressure is recommended for all patients, and continuous positive airway pressure (CPAP) and adaptive servo-ventilation (ASV) are the two primary non-invasive treatment modalities.

It is characterised by cyclical episodes of apnea and hyperventilation

Cheyne-Stokes respiration is a type of breathing disorder characterised by cyclical episodes of apnea and hyperventilation. It is a specific form of periodic breathing, with a waxing and waning amplitude of flow or tidal volume. The breathing pattern is characterised by a crescendo-decrescendo pattern of respiration between central apneas or central hypopneas.

Cheyne-Stokes respiration is an abnormal pattern of breathing, with progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing (apnea). The cycle repeats, with each cycle lasting from 30 seconds to 2 minutes. It is an oscillation of ventilation between apnea and hyperpnea, and is associated with changing serum partial pressures of oxygen and carbon dioxide.

The American Academy of Sleep Medicine (AASM) defines Cheyne-Stokes respiration as a respiratory event with three or more consecutive central apneas and/or central hypopneas, separated by a crescendo-decrescendo change in breathing amplitude with a cycle length of at least 40 seconds. There are also at least five or more central apneas and/or central hypopneas per hour of sleep associated with the crescendo-decrescendo breathing pattern, recorded over a minimum of two hours of monitoring.

Cheyne-Stokes respiration is often observed in patients with acute stroke, with large-artery atherosclerosis or cardioembolism, bilateral hemispheric involvement, atrial fibrillation, low left-ventricle ejection fraction (LVEF), and left atrium (LA) enlargement. It is also associated with heart failure, kidney failure, narcotic poisoning, intracranial pressure, and hypoperfusion of the brain.

The breathing pattern of Cheyne-Stokes respiration can be observed clinically with a cyclic variation of breathing patterns and a change in saturation from 90% to 100%. It is characterised by alternating apnea and hyperventilation during sleep, mostly in the N1 and N2 sleep stages, and also when awake. The apnea/hyperpnea cycle is around 45 to 75 minutes.

It is associated with heart failure and stroke

Cheyne-Stokes respiration is an abnormal breathing pattern characterised by progressively deeper and faster breathing, followed by a gradual decrease until breathing stops temporarily. This cycle repeats, with each lasting between 30 seconds and 2 minutes. It is associated with heart failure and stroke, as well as other conditions such as kidney failure, narcotic poisoning, and intracranial pressure.

Cheyne-Stokes respiration is caused by damage to respiratory centres or physiological abnormalities in congestive heart failure. It is also observed in newborns with immature respiratory systems, in people new to high altitudes, and in severely ill patients nearing the end of life.

Congestive heart failure is a chronic and progressive condition in which the heart cannot pump enough blood to meet the body's needs. Cheyne-Stokes respiration is a common symptom, occurring in 25-50% of patients with advanced heart failure. It is also observed in patients with cerebrovascular strokes and pulmonary hypertension.

Cheyne-Stokes respiration can occur during wakefulness or sleep and is often difficult to diagnose as it happens mostly while the patient is asleep. It is generally indicative of poor prognosis and is associated with reduced survival times. Treatment options include heart failure medications, coronary bypass surgery, and cardiac resynchronization therapy.

It is also seen in patients with traumatic brain injuries

Cheyne-Stokes respiration is an abnormal breathing pattern characterised by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing (apnea). This abnormal pattern can be observed in patients with traumatic brain injuries.

Cheyne-Stokes respiration is often indicative of a serious lung, brain, or circulatory problem. It is also commonly observed in patients with acute stroke, with studies showing that it occurs in 6-72% of patients with acute ischemic stroke. The breathing pattern is unrelated to the infarct location. It is also observed in patients with traumatic brain injuries, with one study finding that it was present in 19.1% of patients with acute stroke.

Cheyne-Stokes respiration can be distressing for family members to witness, but it is not uncomfortable for the patient experiencing it. It is simply the body's way of compensating for physiological changes as the lungs, heart, kidney, liver, and brain start to fail in succession.

The treatment of Cheyne-Stokes respiration depends on the underlying cause. In some cases, such as high altitude, medication overdose, and carbon dioxide poisoning, the condition can be resolved. In other cases, ongoing management will be required.

It can be treated with continuous positive airway pressure (CPAP) and adaptive servo-ventilation (ASV)

Cheyne-Stokes respiration is an abnormal breathing pattern characterised by deeper and faster breathing, followed by a decrease that results in a temporary stop in breathing (apnea). This cycle repeats, with each cycle lasting 30 seconds to 2 minutes. It is often a sign of a serious lung, brain, or circulatory problem, such as pulmonary edema, stroke, or heart failure. It is also common in those approaching the end of life.

Cheyne-Stokes respirations can be treated with continuous positive airway pressure (CPAP) and adaptive servo-ventilation (ASV). CPAP is a form of positive airway pressure therapy that pumps a continuous stream of air into the lungs during sleep, helping to keep the airway open and prevent interrupted breathing. It is often the first-choice treatment for people with central sleep apnea and Cheyne-Stokes breathing. ASV, on the other hand, is an advanced form of positive airway pressure therapy that assesses breathing in real time and adjusts the pressure accordingly. ASV may be used in some patients with central sleep apnea but is not recommended for individuals with heart failure.

In addition to CPAP and ASV, there are other treatment options for Cheyne-Stokes respirations. These include supplemental oxygen therapy, bilevel positive airway pressure (BiPAP or BPAP), nerve stimulation, and respiratory stimulants or depressants. The choice of treatment depends on the underlying cause of the abnormal respiration and the patient's individual needs.

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