Cheyne-Stokes Breathing: What You Need to Know

Cheyne-Stokes breathing is a unique and often misunderstood breathing disorder. It’s characterized by a fluctuating breathing pattern that ends in apnea episodes, in which the person stops breathing for a brief period of time.

Continue reading to learn more about this condition, its symptoms, its causes and how to treat it.

Cheyne-Stokes respiration is a breathing disorder marked by a crescendo-decrescendo pattern.

People with Cheyne-Stokes respiration experience cycles of tachypnea, or shallow and rapid breathing, which then transitions to bradypnea, characterized by deep and slow breaths. These cycles often end in short periods of apnea, in which breathing temporarily stops.

This abnormal breathing pattern can occur both during wakefulness and sleep, but it’s more commonly observed during the non-rapid eye movement stage of sleep (NREM sleep) than in the rapid eye movement stage of sleep (REM sleep) and while awake.

The symptoms of Cheyne-Stokes respiration are somewhat similar to those of sleep apnea and may include:

This is primarily due to disrupted sleep patterns. The irregular breathing interrupts the natural sleep cycle, preventing deep, restorative sleep, causing nighttime arousals and leading to fatigue during the day.

The dysfunction in the respiratory control system causes fluctuations in breathing effort, leading to periods in which breathing may feel harder.

Snoring occurs due to the turbulent airflow created when the throat muscles in the upper airway relax during the slower phases of the breathing cycle.

These coughing fits, particularly at night, are often a response to fluid buildup in the airways or changes in breathing patterns during sleep.

This type of sleep-disordered breathing can be caused by several acute and chronic health conditions. Some of its most common causes are:

Congestive heart failure is a critical condition in which cardiac function is diminished, leading to a low cardiac output, the amount of blood the heart pumps during systole per minute. This inefficiency can lead to a mismatch in oxygen supply and demand within the body’s tissues, including the brain.

The brain responds to these oscillations by altering breathing patterns to stabilize oxygen levels, which can manifest as Cheyne-Stokes respiration. Up to 40% of people with heart failure may experience this type of periodic breathing.

A stroke disrupts the normal blood flow to the brain, damaging the areas responsible for controlling breathing. This damage can lead to abnormal breathing patterns, including Cheyne-Stokes breathing.

Brain injuries, whether due to trauma, tumors, hypoxia or other causes, can impair the respiratory drive from the central nervous system, causing different types of breathing disorders. The severity of these is often associated with the severity of the injury and the location of the brain tumor.

At high altitudes, the body is exposed to lower oxygen levels, which can trigger compensatory mechanisms, such as hyperpnea and other abnormal breathing patterns. In response to environments with a low oxygen level, the body attempts to optimize oxygen uptake and carbon dioxide elimination.

In chronic pulmonary edema, fluid builds up in the respiratory system, creating an inefficient gas exchange in the lungs. This can lead to fluctuations in blood oxygen and carbon dioxide levels, prompting the body to adopt Cheyne-Stokes respiration as a compensatory mechanism to maintain a balance.

The pathophysiology of underlying processes of Cheyne-Stokes respiration aren’t fully understood, but it has been proposed that it can be associated with:

An instability in the respiratory control system can lead to Cheyne-Stokes's oscillating breathing pattern. This instability might be due to varying levels of oxygen and carbon dioxide in the blood, which disrupt the normal feedback mechanism that regulates breathing.

Increased circulation time, particularly in people with congestive heart failure, can result in delayed feedback to the brain regarding blood gas levels. This delay can cause the brain to receive outdated information about the body’s oxygen and carbon dioxide levels, contributing to the development of Cheyne-Stokes respiration.

The body's bicarbonate buffer system helps maintain a normal pH by regulating carbon dioxide levels through exhalation. In Cheyne-Stokes respiration, hyperventilation can deplete the body’s total carbon dioxide stores, interfering with this buffering capacity and leading to the characteristic breathing pattern.

Diagnosing Cheyne-Stokes respiration is a critical step in managing this complex breathing disorder. The process involves a combination of clinical assessment and diagnostic tests to identify its presence, severity, and underlying cause accurately.

The initial step in diagnosing Cheyne-Stokes is a thorough clinical evaluation, including a physical examination and a detailed medical history. It’s important to understand the patient’s overall health, sleep patterns, and any previous diagnoses that could be related to their breathing irregularities.

Performing a polysomnography, commonly known as a sleep study, is fundamental for diagnosing Cheyne-Stokes breathing. This comprehensive test records various body functions during sleep, including brain activity, eye movements, heart rate, blood pressure, oxygen levels, sleep cycle length and breathing patterns. This test is usually conducted by a sleep technician and interpreted by a sleep medicine specialist.

Oximetry is a non-invasive test that measures the oxygen saturation level in the blood. While it doesn’t diagnose Cheyne-Stokes alone, it can be used with a sleep study to provide additional information about the patient’s oxygen levels during sleep and potential episodes or hypoxemia or low blood oxygen levels.

Given the strong association between Cheyne-Stokes and heart failure, echocardiography may be performed to assess the heart’s ventricular function. This test can help determine if a patient’s Cheyne-Stokes breathing is related to a heart issue.

In some cases, further tests may be necessary to rule out other conditions or to gain a more comprehensive understanding of the patient’s respiratory and cardiovascular health. These may include:

• Electrocardiogram to check for heart arrhythmias.
• Magnetic resonance imaging or computed tomography scans to detect brain abnormalities or injuries.
• Blood tests to evaluate for conditions that might affect breathing, such as kidney failure or electrolyte imbalances.

Understanding the differences between Cheyne-Stokes respiration and sleep apnea syndrome is essential for accurate diagnosis and treatment. While both disorders affect breathing during sleep, they have different characteristics and implications.

Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the upper airway is physically blocked, often by relaxed throat muscles, leading to apnea and hypopnea during sleep.

This blockage prevents adequate airflow, despite the effort to breathe. Sleeplay’s Home Sleep Study offers a convenient and hassle-free way for those who think they may have OSA to get a diagnosis from the comfort of their home.

Central sleep apnea (CSA) is a type of sleep apnea in which the brain fails to send proper signals to the muscles that control breathing. This results in a temporary cessation of breathing. This type of central apnea is characterized by a consistent absence of respiratory effort during apnea episodes.

Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis. It lacks the cyclic nature of Cheyne-Stokes, and it’s a constant, deep, rapid breathing pattern.

Hypoventilation is when breathing is too shallow or slow, leading to increased levels of carbon dioxide in the blood.

Hyperventilation is rapid or deep breathing that can happen as a response to stress or pain. It doesn’t usually lead to periods of apnea.

Biot’s respiration is characterized by groups of quick, shallow breaths followed by regular or irregular periods of apnea. Changes in this type of breathing aren’t gradual like those in Cheyne-Stokes.

The treatment of Cheyne-Stokes is tailored to address the underlying causes and alleviate its symptoms. This usually involves a combination of lifestyle changes to address risk factors, medical therapy, and specialized breathing assistance devices. The most common treatment options are:

People with Cheyne-Stokes breathing may benefit from:

•Weight Management: Maintaining a healthy weight can reduce the severity of Cheyne-Stokes.

•Adequate Sleep Hygiene: Establishing a regular sleep schedule and creating a comfortable sleep environment can improve sleep quality.

•Avoiding Alcohol and Sedatives: These substances can worsen breathing irregularities during sleep.

Depending on the underlying cause, medications for heart failure or the central nervous system may be prescribed. In some cases, respiratory stimulants, such as theophylline, may be used to treat Cheyne-Stokes breathing. However, due to potential side effects, they should be used with caution, under medical supervision.

Supplemental oxygen during sleep can help maintain adequate oxygen levels in the blood, reducing the occurrence of apnea episodes associated with Cheyne-Stokes respiration. This can improve unpleasant symptoms and quality of life.

CPAP therapy is commonly used to treat sleep apnea, but it can also benefit Cheyne-Stokes respiration. It works by delivering a steady stream of air through a mask to keep the airway open throughout the night. At Sleeplay , you can find the best CPAP machines on the market.

ASV is a newer form of ventilatory support that adjusts air pressure based on the detection of apnea episodes and abnormal breathing patterns. It is particularly useful for people with Cheyne-Stokes respiration. If you’re looking for an ASV machine to start your treatment, Sleeplay is the online store for you.

This is an emerging treatment that involves stimulating the phrenic nerve to improve diaphragm function and restore a normal breathing pattern.

The treatment of Cheyne-Stokes respiration often involves regular follow-ups with a healthcare provider to monitor the condition and adjust treatments as necessary. Patients need to be aware of their symptoms and seek medical attention if they experience any changes in their condition.