Cheyne-Stokes breathing is the name for a pathological form of breathing. It involves regular changes in the depth of breathing as well as changes in the spacing of breaths.
What is Cheyne-Stokes respiration?
Cheyne-Stokes respiration refers to an abnormal breathing pattern characterized by the swelling and decongestion of breathing that is accompanied by prolonged pauses in breathing. If breathing periodically flattens during this process, there is a risk of respiratory arrest lasting a short time. Subsequently, however, deeper breaths resume. Cheyne-Stokes respiration often occurs when the affected person has insufficient blood flow to the brain. This can be caused by vascular sclerosis, for example. Other conceivable triggers are a stroke or poisoning. The Scottish physician John Cheyne (1777-1836) and the Irish physician William Stokes (1804-1878) gave their names to Cheyne-Stokes respiration. In 1818, John Cheyne succeeded in describing the periodic waxing and waning of respiration. Only a short time later, William Stokes did the same. Cheyne-Stokes respiration is more common in men than in women. Almost always, patients are older than 60 years.
Causes
Cheyne-Stokes respiration is thought to be caused by nonlinear respiratory center sensitivity to CO2 partial pressure within the arterial blood. The increase in CO2 partial pressure acts as the strongest respiratory stimulus. This causes the respiratory rate as well as the depth of breaths to decrease until increased breathing is made possible by a higher CO2 content within the blood. If the affected person exhales sufficient CO2, breathing flattens out again. Because sensitivity to CO2 is disproportionately low at low partial pressure and disproportionately high at high partial pressure, this results in oscillation of the respiratory regulator. There is debate in the medical community as to whether Cheyne-Stokes respiration can have a negative effect on the progression of heart failure. The more severe the heart failure presents, the more intense the periodic and central breathing patterns. The most common triggers for Cheyne-Stokes respiration include inadequate cerebral blood supply, such as from deficient perfusion in atherosclerosis, stroke, or poisoning, such as from carbon monoxide.
Symptoms, complaints, and signs
Cheyne-Stokes respiration represents a severe form of breathing disorder during sleep. It is associated with marked forms of heart failure. For example, the prevalence of this pathologic form of breathing in heart failure patients is between 30 and 40 percent. A typical feature of Cheyne-Stokes respiration is the periodically repeated waxing and waning of the breath. The patient’s breaths become increasingly shallow until there is a short pause of about ten seconds. After that, the breaths become deeper and more labored again. In some cases, there is also an additional change in breathing frequency during this process. Cheyne-Stokes respiration is particularly noticeable at night in people suffering from advanced heart failure. However, it often manifests in other central nervous system damage such as opioid overdoses, exogenous poisoning, or uremia. Cheyne-Stokes respiration may be the preliminary stage of preterminal gasping. However, it sometimes presents during the normal sleep process without having any pathologic value. Often Cheyne-Stokes breathing occurs during sleep at altitudes above 3000 meters and is called periodic breathing. Periodic breathing is not classified as an altitude sickness symptom, but sometimes causes sleep disturbances. In some cases, Cheyne-Stokes breathing causes the patient to wake up because he or she is experiencing shortness of breath.
Diagnosis and course
If Cheyne-Stokes breathing is suspected, a polysomnographic examination in a special sleep laboratory is required. Polysomnography is a diagnostic procedure that specifically measures the patient’s physiologic functions during sleep. It is the most comprehensive examination of this kind. The examination takes place on an inpatient basis. This gives the physician the opportunity to create an individual sleep profile of the patient, which facilitates the diagnosis of Cheyne-Stokes respiration.During the examination, a sleep EEG (brain wave image), ECG (measurement of heart rhythm), EMG (muscle tension) or EOG (eye movements) can be performed. Video or audio recordings and measurement of blood pressure are also within the realm of possibility. If the underlying disease causing Cheyne-Stokes respiration can be successfully treated, the patient’s prognosis is usually positive.
Complications
Cheyne-Stokes respiration is characterized by severe respiratory complications that occur primarily during sleep. In this case, the symptom is also closely associated with heart failure. The patient’s breathing rate also changes with time, thus having a negative impact on the body’s health. Due to the altered breathing, damage to the patient’s nervous system can also occur, and Cheyne-Stokes breathing can also manifest itself in the form of gasping breathing. The affected person is not directly awakened by the incorrect breathing, so many patients are able to sleep without discomfort. However, as the disease progresses, the patient suffers from sleep disturbances and wakes up experiencing shortness of breath. Often the shortness of breath is accompanied by a panic attack. The treatment of Cheyne-Stokes respiration is usually causal and is mainly aimed at treating kidney weakness or diabetes. Afterwards, the patient must undergo respiratory therapy to prevent secondary damage in the process. Complications usually occur only if the improper breathing is not treated or if complications occur due to the underlying disease.
When should you see a doctor?
When the characteristic waxing and waning of the breath is noted, a physician should be consulted. Medical evaluation is necessary, first, because of the potential risks of a disordered breathing pattern. On the other hand, Cheyne-Stokes breathing often underlies a serious condition that must be diagnosed and, if necessary, treated. Therefore, at the latest when complications arise from the breathing problems, medical clarification is necessary. Cheyne-Stokes respiration primarily affects people who suffer from arteriosclerosis or have had a stroke. Carbon monoxide poisoning can also cause the impaired breathing rate. The condition also occurs in conjunction with diabetes mellitus, kidney weakness, heart failure and some other diseases. Anyone in these high-risk groups should talk to their primary care physician immediately if they experience the symptoms mentioned above. Further contacts are the lung specialist or a sleep laboratory. Parents who notice an unusual breathing pattern in their child are best to talk to their pediatrician. If there is extreme shortness of breath or signs of hypoxia, emergency medical services must be alerted.
Treatment and therapy
Therapy for Cheyne-Stokes respiration is composed of two stages. Stage 1 involves treatment of the precipitating underlying condition. This may be heart failure, renal impairment, diabetes mellitus (diabetes), or other conditions. Stage 2 provides for ventilation therapy. It aims to change the pathophysiological breathing pattern to a physiological breathing pattern. Commonly used ventilation methods are AZMV (anticyclic modulated ventilation) or ASV (adaptive servoventilation). In these methods, a mask system is applied to the patient. It enables automatic regulation of respiratory pressure. It also dampens the oscillation of the regulation in a mechanical way. The respiratory oscillations due to Cheyne-Stokes breathing are countercyclically compensated, while the pathophysiological respiratory patterns take a physiological direction. In addition, in some patients, administration of supplemental oxygen can linearize the respiratory response curve and thus dampen the oscillatory respiratory regulation. If the patient suffers from altitude sickness, it is necessary for him to descend immediately to lower altitudes until all symptoms improve. In this way, he regains an adequate supply of oxygen.
Outlook and prognosis
In general, the subsequent course of Cheyne-Stokes respiration is relatively dependent on the underlying disease. Therefore, it is not possible to make a general statement about the prognosis of this disease. If the underlying disease can be cured, this will usually also control Cheyne-Stokes respiration.However, complaints of the heart or kidneys can usually not be completely resolved, so that the symptoms of Cheyne-Stokes respiration are also not completely limited. In the case of diabetes, the condition can usually be relatively well suppressed. Special ventilation therapy also limits the chronic symptoms. However, a complete cure is not achieved by this either. In the case of altitude sickness, Cheyne-Stokes respiration can also be resolved by descent. In this case, the symptoms usually reappear when the affected person goes to a high altitude. The condition can also be relieved in many cases by self-help remedies or by not using drugs. Ventilators can also be used in the patient’s own home, so that an inpatient stay is not absolutely necessary for the patient. Relaxation exercises can also reduce the discomfort of the disease in the process.
Prevention
Preventive measures against Cheyne-Stokes respiration are not known. Regular medical examinations are considered important.
Follow-up care
In most cases of Cheyne-Stokes respiration, measures of follow-up care are very limited. First and foremost, early detection is very important in this disease to prevent further complications or discomfort. The earlier Cheyne-Stokes respiration is detected by a doctor, the better the further course of the disease usually is. Possibly, this disease can also lead to a reduced life expectancy. For this reason, the affected person should see a doctor at the first symptoms and signs of the disease, so that it does not come to a further worsening of the symptoms. The treatment itself depends on the underlying disease. If this is treated by surgery, it is recommended that the affected person rest after the procedure and refrain from physical or stressful activities. Attention should also be paid to a healthy lifestyle with a healthy diet. In many cases, however, it is also necessary to take medication to alleviate the symptoms. Here, attention must be paid to regular intake with a correct dosage. The further course of Cheyne-Stokes respiration depends thereby strongly on the basic illness, so that thereby no general course can be given.
What you can do yourself
Triggers of Cheyne-Stokes respiration can be an altered breathing rhythm, brain damage and a pathological heart defect. Affected individuals must therefore be able to initiate various self-help measures for their daily lives, as well as instruct their relatives to do so. The syndrome usually occurs at night during sleep phases. Breathing stops and increased waking reactions of the body occur. Healthy deep sleep is not possible. The fear of total respiratory arrest can take hold of the affected person to such an extent that a normal course of life hardly seems possible. Patients with Cheyne-Stokes respiration often appear severely overtired and exhausted. It is very important to lead a balanced lifestyle and to abstain from alcohol, smoking and drugs of any kind. Stimulants or sleep-inducing drugs do not help the patient, but have a physically destructive effect. A balanced diet rich in vitamins is also advisable, especially for patients with heart failure and overweight. Home ventilators are increasingly being used as a useful form of self-help. Beforehand, however, the syndrome should be precisely examined in a sleep laboratory. Regular therapeutic oxygen administration and regulating medication help the patient to cope better with everyday life. To control breathing and maintain lung capacity, gentle exercise such as yoga and swimming can be supportive. In general, stress, extreme physical exertion and high-fat food should be avoided.