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Cheyne-Stokes respiration is an abnormal breathing pattern characterized by a gradual increase then decrease in respiration
Cheyne-Stokes respiration is an abnormal breathing pattern characterized by a gradual increase then decrease in respiration that may be seen over a period of many hours. It has two alternating periods:
- Hypercapnic period or rapid, deep respiration
- Apnea or stopped breathing
After an episode of apnea or hypopnea, the pattern repeats in a cycle, with each cycle typically lasting around 45-90 seconds.
Who is at risk of Cheyne-Stokes respiration?
Cheyne-Stokes breathing often occurs during deep sleep and may be seen in newborn babies. Conditions associated with Cheyne-Stokes breathing include:
- Central sleep apnea
- Altitude sickness
- Severe heart failure
- Stroke
- Head injury
- Chronic hypoxia
- Diffuse cerebral atrophy
- Increased intracranial pressure
- Carbon monoxide poisoning
- Severe electrolyte imbalances
- Severe pneumonia
- Narcotic drug poisoning
- Obstructive sleep apnea (rare)
A repeated pattern of Cheyne-Stokes respiration in chronically ill patients indicates poor prognosis and often impending death. It may also indicate low sodium levels, brain injury, or coma.
How does Cheyne-Stokes respiration happen?
Your respiratory center lies in the brain stem and is stimulated by:
- Increased carbon dioxide levels in the blood (primary stimulant)
- Reduced oxygen levels (secondary stimulant)
Increased oxygen levels depress the respiratory center and cause a temporary pause in breathing until blood carbon dioxide levels rise and stimulate the respiratory center.
This negative feedback allows for steady and stable tissue levels of oxygen and carbon dioxide (CO2). In cases of heart failure or stroke, the spontaneous rhythmic activity of breathing is stopped. Thus, there is a gradual buildup of hypoxia, which causes simultaneous accumulation of carbon dioxide in the blood. The excess CO2 hyperstimulates the respiratory centers and causes hyperventilation. This causes CO2 to wash out from the blood and result in depression of the respiratory center, causing episodic apnea. This triggers hypoxia and the next episode of CO2 buildup. The cycle is repeated.
What are the signs and symptoms that accompany Cheyne-Stokes respiration?
People with Cheyne-Stokes respiration may experience the following symptoms:
- Orthopnea: Inability to breathe upon lying down
- Paroxysmal nocturnal dyspnea: Shortness of breath that occurs mostly at night and disrupts sleep
- Fatigue: Daytime drowsiness due to insufficient sleep during the night.
How is Cheyne-Stokes respiration managed?
Because Cheyne-Stokes respiration is a symptom, the underlying cause must be treated.
- Oxygen supplementation: Oxygen supplementation increases the oxygen level in the blood and reduces the risk of Cheyne-Stokes respiration. Nighttime oxygen supplementation has been found to be particularly useful.
- Continuous positive airway pressure (CPAP): This is the treatment of choice for sleep apnea. With CPAP therapy, a mask is worn over the mouth, nose, or both and then connected to a CPAP machine, which provides positive airflow to keep the airway open.
If Cheyne-Stokes respiration is not managed, it can cause an increase in carbon dioxide levels in the blood, leading to tissue hypoxia, organ failure, and eventually death.
What are other abnormal respirations?
Other abnormal respirations include:
- Kussmaul breathing: Deep, labored, fast breathing that occurs due to metabolic acidosis. It is mostly seen in diabetic ketoacidosis.
- Hyperventilation: Characterized by deep, rapid breathing that leads to low carbon dioxide and high oxygen in the blood. Mostly seen with chronic stress and anxiety or panic attacks.
- Biot respiration: Erratic respiratory pattern with alternating rapid short breaths and pauses, caused by damage in the respiratory center.
