Cheyne-Stokes breathing is a form of periodic breathing characterized by alternating periods of central apnea or hypopnea and hyperpnea. It occurs due to anoxia abolishing spontaneous breathing, leading to CO2 accumulation and subsequent hyperventilation which washes out CO2 and causes further apnea. This cycle then repeats. Conditions associated with Cheyne-Stokes breathing include severe heart failure, uremia, chronic hypoxia, cerebral trauma and hemorrhage. Consequences include increased intracranial pressure, pneumonia, oscillations in blood pressure and heart rate, and poor sleep quality. Management involves treating the underlying cause, along with medications, oxygen therapy or positive pressure ventilation.

1. ‫الرحیم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. CHEYNE-STOKES
BREATHING
MECHANISM, CAUSES, CONSEQUENCES AND MANAGEMENT

3. DEFINITION
 This is a form of periodic breathing characterized by alternating periods of
central apnea ( or hypopnea) and hyperpnoea.
 The rate and depth of respiration increase to a maximum over a period of a
few minutes, then decrease until breathing virtually ceases.
 The patient lies motionless for 10-20 seconds (apnea). Then the cycle is
repeated.

4. MECHANISM
 Anoxemic abolishes the spontaneous rhythmic activity of breathing.
Consequent apnea results in accumulation of carbon dioxide. This
hypercapnia stimulates respiratory centers resulting in hyperventilation. The
hyperventilation leads to carbon dioxide wash out and results in depression
of the respiratory center leading to apnea. The cycle is repeated.
 Apneas are more severe when the patient is supine because pulmonary
congestion worsens on lying flat, which activates afferent receptors present
in lung ("J" receptors) and induces hyperventilation.

5. CONDITIONS ASSOCIATED WITH CHEYNE-STOKES BREATHING
 Severe heart failure
 Uremia
 Chronic hypoxia
 Cerebral trauma and hemorrhage

6. CONSEQUENCES
 Increased intracranial pressure
 Severe pneumonia
 Narcotic drug poisoning
 Normal subjects living at high altitude
 Alternating cycles of hyper- and hypoventilations provoke oscillations in blood pressure,
heart rate and tidal volume.
 This leads to a state of physiological instability in the already stressed cardiovascular system
in patients with congestive heart failure (CHF).
 Poor sleep quality leads to daytime somnolence, fatigue, impaired quality of life and
insomnia.

7. MANAGEMENT
 Treatment of underlying cause.
 In patients with CHF, theophylline, acetazolamide or benzodiazepines have
been used with varying success.
 Oxygen therapy.
 Positive pressure ventilation.