CheyneStokesandning

Cheyne-Stokes respiration, also known as Cheyne-Stokes andning, is a pattern of periodic breathing characterized by a cyclical crescendo and decrescendo of tidal volume followed by brief central apneas. The cycles typically last about 30 seconds to 2 minutes and can occur during sleep or wakefulness, often in people with serious medical conditions.

Causes and mechanism: Cheyne-Stokes respiration commonly appears in advanced congestive heart failure and after stroke or brain injury. It is also seen with other CNS disorders, high altitude exposure, and certain drug effects that depress the respiratory drive. The proposed mechanism involves delayed feedback control of ventilation due to prolonged circulatory time and altered chemoreceptor sensitivity, which leads to oscillations in arterial CO2 and repetitive epochs of increasing breathing, decreasing breathing, and apnea.

Diagnosis and management: Diagnosis is usually made via observation and confirmed with polysomnography or arterial blood gas analysis, documenting the characteristic crescendo-decrescendo breathing pattern with recurring apneas. Management focuses on treating the underlying condition, such as optimizing heart failure therapy or addressing neurologic injury. In selected patients with central sleep apnea and Cheyne-Stokes respiration, nocturnal noninvasive ventilation options (for example, adaptive servo-ventilation or bilevel positive airway pressure) may be considered after careful evaluation. Supplemental oxygen can improve hypoxemia in some cases but does not address the ventilatory control abnormality and may have other risks depending on the patient. Prognosis largely depends on the underlying disease and its severity.