Diseases

Cheyne-Stokes Respiration – Causes, Symptoms & Treatment

Cheyne-Stokes-Atmung

Cheyne-Stokes breathing is the name for a pathological form of breathing. This leads to a regular change in breathing depth and changes in breathing intervals.

What is Cheyne-Stokes breathing?

Cheyne-Stokes breathing is understood to mean a pathological breathing pattern that becomes noticeable through the swelling and slacking of breathing, which is associated with longer breathing pauses. If breathing flattens out periodically during this process, there is a risk of brief respiratory arrest .

However, this is followed by deeper breathing. Cheyne-Stokes respiration often occurs when a person has insufficient blood flow to the brain. This can be caused, for example, by vascular sclerosis . Other conceivable triggers are a stroke or poisoning .

The Scottish physician John Cheyne (1777-1836) and the Irish physician William Stokes (1804-1878) gave Cheyne-Stokes breathing its name. In 1818, John Cheyne succeeded in describing the periodic rise and fall of breathing. Only a short time later, William Stokes did the same. Cheyne-Stokes breathing is more common in men than in women. The patients are almost always older than 60 years.

causes

The cause of Cheyne-Stokes respiration is considered to be a non-linear respiratory center sensitivity to the CO2 partial pressure within the arterial blood. The increase in the CO2 partial pressure acts as the strongest respiratory stimulus. As a result, the respiratory rate and the depth of the breaths decrease until increased breathing is made possible by a higher CO2 content in the blood.

If the affected person exhales sufficient CO2, breathing becomes shallow again. Because the sensitivity to CO2 is disproportionately low when the partial pressure is low and is disproportionately high when the partial pressure is high, this results in the regulator oscillating. There is a debate in medicine as to whether Cheyne-Stokes breathing can have a negative impact on the course of heart failure .

The more severe the heart failure presents itself, the more intense are the periodic and central breathing patterns. One of the most common triggers for Cheyne-Stokes respiration is a deficient cerebral blood supply, such as that caused by insufficient blood flow in the case of arteriosclerosis , a stroke, or poisoning such as carbon monoxide.

Symptoms, Ailments & Signs

Cheyne-Stokes breathing is a severe form of breathing disorders during sleep. It is associated with pronounced forms of heart failure. The prevalence of this pathological form of breathing in heart failure patients is between 30 and 40 percent.

A typical feature of Cheyne-Stokes breathing is the periodically repeated swelling and swelling of breathing. The patient’s breathing becomes shallower and shallower until there is a brief pause of about ten seconds. Then the breaths become deeper and more labored. In some cases, this process also leads to an additional change in the respiratory rate.

Cheyne-Stokes breathing is particularly noticeable at night in people suffering from advanced cardiac insufficiency. However, it often also occurs with other damage to the central nervous system such as opioid overdoses, exogenous poisoning or uraemia.

Cheyne-Stokes breathing can be the precursor to preterminal gasping. Sometimes, however, it also shows up during the normal sleep process without having any pathological value. Cheyne-Stokes breathing often occurs during sleep at altitudes greater than 10,000 feet and is referred to as periodic breathing.

Periodic breathing is not classified as a symptom of altitude sickness , but it can sometimes cause sleep disturbances . In some cases, Cheyne-Stokes breathing wakes the patient up because they are short of breath.

Diagnosis & History

If Cheyne-Stokes respiration is suspected, a polysomnographic examination in a special sleep laboratory is required. Polysomnography is a diagnostic procedure in which the patient’s physiological functions are specifically measured during sleep. It is the most comprehensive study of its kind.

The examination takes place on an inpatient basis. This gives the doctor the opportunity to create an individual sleep profile for the patient, which facilitates the diagnosis of Cheyne-Stokes respiration. As part of the examination, a sleep EEG (brain current image), EKG (heart rhythm measurement), EMG (muscle tension) or EOG (eye movements) can be performed.

Video or audio recordings as well as measuring blood pressure are also possible. If the underlying disease causing Cheyne-Stokes respiration can be successfully treated, the patient’s prognosis is usually positive.

complications

Serious breathing complications occur with Cheyne-Stokes breathing, especially during sleep. The symptom is also closely linked to heart failure. The patient’s breathing rate also changes over time and thus has a negative impact on the health of the body.

The altered breathing can also cause damage to the patient’s nervous system, with Cheyne-Stokes breathing also showing up as gasping. The affected person is not directly awakened by the wrong breathing, so many patients can sleep without discomfort. However, as the disease progresses, the patient suffers from insomnia and wakes up suffering from shortness of breath.

Shortness of breath is often accompanied by a panic attack. The treatment of Cheyne-Stokes respiration is usually causal and is primarily aimed at treating kidney weakness or diabetes. The patient then has to undergo ventilation therapy to prevent consequential damage. Complications usually only arise if improper breathing is left untreated or if there are complications from the underlying condition.

When should you go to the doctor?

If the characteristic swelling and swelling of the breath is noticed, a doctor should be consulted. A medical investigation is necessary on the one hand because of the possible risks of a disturbed breathing pattern. On the other hand, Cheyne-Stokes breathing is often based on a serious condition that needs to be diagnosed and, if necessary, treated. At the latest when complications arise from the breathing difficulties, a medical examination is therefore necessary.

Cheyne-Stokes breathing primarily affects people who suffer from arteriosclerosis or have suffered a stroke. Carbon monoxide poisoning can also cause the disturbed respiratory rate. The disease also occurs in connection with diabetes mellitus, kidney failure, heart failure and some other diseases.

Anyone who belongs to these risk groups should speak to their family doctor immediately if they experience the symptoms mentioned. Other contacts are the lung specialist or a sleep laboratory. Parents who notice an unusual breathing pattern in their child are best advised to speak to the pediatrician . In the event of extreme shortness of breath or signs of insufficient oxygen supply, the emergency services must be alerted.

Treatment & Therapy

Cheyne-Stokes breathing therapy consists of two stages. In stage 1, the triggering underlying disease is treated. This can be heart failure, kidney failure, diabetes mellitus (diabetes) or other diseases.

Level 2 provides ventilation therapy. It pursues the goal of converting the pathophysiological breathing pattern to a physiological breathing pattern. Common ventilation methods are AZMV (anti-cyclically modulated ventilation) or ASV (adaptive servo ventilation). In these procedures, a mask system is fitted to the patient. It enables automatic respiratory pressure regulation.

In addition, it mechanically dampens the swinging of the regulation. The fluctuations in breathing caused by Cheyne-Stokes breathing are balanced countercyclically, while the pathophysiological breathing patterns take a physiological direction.

In addition, in some patients, the administration of supplemental oxygen can linearize the respiratory response curve and thus dampen the oscillating respiratory regulation. If the patient suffers from altitude sickness, it is necessary for him to descend immediately to lower regions until all symptoms improve. In this way, he receives a sufficient supply of oxygen again.

Outlook & Forecast

As a rule, the further course of Cheyne-Stokes breathing depends relatively heavily on the underlying disease. A general statement about the prognosis of this disease is therefore not possible. If the underlying disease can be cured, this usually also combats Cheyne-Stokes breathing.

However, most heart or kidney problems cannot be completely solved, so that the problems of Cheyne-Stokes breathing are not completely reduced either. In the case of diabetes , the disease can usually be suppressed relatively well. The chronic symptoms are also limited by a special ventilation therapy. However, this does not result in complete healing. In the case of altitude sickness , Cheyne-Stokes breathing can also be relieved by descending. The symptoms usually reappear when the person concerned goes to a great height.

In many cases, the disease can also be alleviated by self-help or by not using drugs. Ventilators can also be used at home, so that the patient does not necessarily have to stay in hospital. Relaxation exercises can also reduce the symptoms of the disease.

prevention

There are no known preventive measures against Cheyne-Stokes respiration. Regular medical examinations are important.

aftercare

In the case of Cheyne-Stokes breathing, the follow-up measures are very limited in most cases. In the case of this disease, early detection is very important in the first place, so that there are no further complications or symptoms. The earlier Cheyne-Stokes breathing is recognized by a doctor, the better the further progression of the disease.

This disease can also lead to a reduced life expectancy. For this reason, the person affected should consult a doctor as soon as the first symptoms and signs of the disease appear, so that the symptoms do not worsen further. The treatment itself depends on the underlying disease.

If this is treated by surgery, it is advisable for the person concerned to rest after the procedure and to refrain from physical or stressful activities. It is also important to have a healthy lifestyle with a healthy diet. In many cases, however, medication is also necessary to relieve the symptoms.

It is important to ensure that it is taken regularly with the correct dosage. The further course of Cheyne-Stokes breathing depends heavily on the underlying disease, so that no general course can be given.

You can do that yourself

Cheyne-Stokes breathing can be triggered by a changed respiratory rhythm, brain damage and a pathological heart defect. Those affected must therefore be able to initiate various self-help measures for their everyday life and instruct their relatives accordingly.

The syndrome usually occurs at night during sleep phases. Breathing stops and the body wakes up more often. A healthy deep sleep is not possible. The fear of total respiratory arrest can affect those affected so much that a normal life seems hardly possible. Patients with Cheyne-Stokes breathing often appear severely overtired and exhausted.

A balanced lifestyle and abstinence from alcohol , smoking and drugs of any kind are very important. A balanced diet rich in vitamins is also advisable , especially for patients with cardiac insufficiency and overweight .

As a sensible form of self-help, ventilators are increasingly being used for home use. Before that, however, the syndrome should be examined in detail in a sleep laboratory . Regular therapeutic oxygen administration and regulating medication help the patient to cope better with everyday life. Gentle exercise such as yoga and swimming can help to control breathing and maintain lung capacity. Stress , extreme physical exertion and high-fat food should generally be avoided .

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.