Cheyne-stokes respiration is an abnormal pattern of breathing which occurs in patients with congestive heart failure, neurological diseases, and central sleep apnea.
The breathing pattern is increased and decreased gradually like tidal volume with periods of sleep apnea.
Cheyne-stokes respiration is caused by the failure of the respiratory center in the brain to compensate quickly for changing serum partial pressure of carbon dioxide and oxygen. This abnormal breathing pattern can be seen in patients with head injuries, strokes, and brain tumors.
Sometimes, it can occur in normal people during sleep at high altitudes. Cheyne-stokes respiration is also associated with arrthymias such as two fold rise in the incidence of ventricular premature beats during slow wave sleep and other forms of stable sleep. Day time sleep also results with cheyne-stokes respiration.
Patterns of cheyne-stokes respiration:
Cheyne-stokes respiration has alternate periods of no breathing changing smoothly into periods of hyper breathing, which smoothly change back into no breathing. This type of breathing is abnormal and can occur during sleep or wakefulness. If it occurs in wakefulness, it is a sign of more advanced disease.
If a person who is sleeping has cheyne-stokes respiration, the apnea durations are ten seconds or larger, and if there are more than five such apneas per hour of sleep, then the person has central sleep apnea.
Heart failure and cheyne-stokes respiration:
Why your brain commands abnormal breathing when the heart is weak? Before knowing the reason, first you should know how the breathing is controlled.
Your body status is continuously monitored by your brain and it decides the proper rate and depth of breathing to command. The brain also monitors how much carbon dioxide is present in your blood.
Your brain sends a command to the breathing muscles when the level of carbon dioxide is too high. When you breathe, the carbon dioxide level in the blood is decreased.
The stimulus to the breath will not be there until the carbon dioxide rises again to the high level. As your body continuously produces carbon dioxide, it reaches to high level in few seconds and the cycle starts again.
Heart failure disrupts this cycle resulting in cheyne-stokes respiration. I heart failure, the blood circulates slowly more slowly through the body. As a result, the levels of carbon dioxide seen by the brain are not current information but it is several seconds’ earlier information.
As the brain acts on old information, large swings in breathing depth and rate occur. The brain does not learn the delay in levels of carbon dioxide and the swings in breathing continue.
Cheyne-stokes respiration diagnosis and treatment:
The diagnosis of cheyne-stokes respiration requires an overnight polysomnography performed in a sleep lab.
The cheyne-stokes respiration can be treated by treating the heart failure. The blood circulation becomes shorter. The treatment includes angiotensin converting enzyme inhibitors or digoxin.
With persisting cheyne-stokes respiration, continuous positive airway pressure (CPAP) can be used. Continuous positive airway pressure (CPAP) has been shown to improve cardiac function and quality of life.