CheyneStokes

Cheyne–Stokes respiration, also known as Cheyne-Stokes breathing, is an abnormal pattern of breathing characterized by cycles of gradually increasing and then decreasing tidal volume, followed by a period of apnea. It is named after English physician John Cheyne and Irish-born William Stokes, who described the pattern in the 19th century. The pattern is most evident during sleep but can be observed when a patient is awake.

In a typical cycle, breathing waxes and wanes over roughly 30 seconds to 2 minutes. There is a crescendo of breathing, then a decrescendo, culminating in a temporary pause of breathing (apnea) lasting several seconds. The periodic, waxing and waning pattern distinguishes Cheyne–Stokes respiration from regular, steady breathing.

Cheyne–Stokes respiration is not a disease itself but a sign of underlying conditions. It is commonly associated with advanced congestive heart failure and various central nervous system disorders, including stroke, brain injury, brainstem disease, and tumors. It can also appear in severe metabolic encephalopathy, during sleep in some individuals, and in severe hypoxic states such as high altitude. In some cases it may occur in otherwise healthy elderly individuals.

The pathophysiology involves delayed circulatory time and instability in the respiratory control system, with an exaggerated response to fluctuations in CO2 levels. Diagnosis is clinical and may be supported by monitoring or polysomnography. Management focuses on treating the underlying condition; supplemental oxygen or noninvasive ventilation (for example, CPAP) may reduce episodes in selected patients. In advanced disease, Cheyne–Stokes respiration can indicate poor prognosis.