Cheyne-Stokes Respiration in Patients with Cardiac Enlargement and Prolonged Circulation Time

Abstract

A study has been made of arterial blood changes during the respiratory cycle in patients with cardiac enlargement, prolonged circulation time, and Cheyne-Stokes breathing. In these patients, Cheyne-Stokes breathing appeared to depend upon the delay in passage of blood from the lungs to the arterial chemoreceptors and respiratory center. This delayallowed cyclic over- and underventilation. There was little or no central nervous system depression. In contrast, one case of Biot's breathing is presented as an example of another mechanism responsible for periodic breathing. Here irregular breathing seems to depend on fluctuations in activity of a severely damaged central nervous system.

The Mechanism of Cheyne-Stokes Respiration*

“…b) The absence of significant arterial oxygen unsaturation (except in Cases 5, 8, and 9) is in agreement with other reports (3,5,7). None of the patients appeared cyanotic during any portion of the respiratory cycle, nor was clubbing found.…”

“…There is, however, evidence that mild anoxemia potentiates the effects of Paco2 on the carotid body or medullary receptors (9,10). c) Previous studies have shown varying degrees of hypocapnea (3,7). In the present study analysis of end-tidal gas reveals a lowered PACO2 at all times.…”

“…None of the patients appeared cyanotic during any portion of the respiratory cycle, nor was clubbing found. These findings rule out persistent anoxemia as a primary mechanism for respiratory control in these subjects, in contrast to its presumed role in cases of cerebral contusions and brain tumor (3). There is, however, evidence that mild anoxemia potentiates the effects of Paco2 on the carotid body or medullary receptors (9,10).…”

Effects of acute changes in pulmonary wedge pressure on periodic breathing at rest in heart failure patients

“…In chronic disease states such as HF, a potential contributor to the alterations in matching between the peripheral feedback and regulatory activity of the CNS includes circulatory delay 8,9,20,32,33 . When blood transport slows (i.e.…”

Ventilatory control in patients with sleep apnoea and left ventricular dysfunction: comparison of obstructive and central sleep apnoea

“…This breathing abnormality, characterized by alternating periods of hyperpnoea and hypopnoea or apnoea, is one form of central apnoea and appears to be much more common during sleep (central sleep apnoea (CSA)) than wakefulness [3]. The main mechanism responsible for Cheyne-Stokes respiration is believed to be a phase delay between peripheral and central chemoreceptors due to prolonged circulation time [4]. This phase delay would promote unstable respiratory control, leading to periodic respiration with alternating hyperpnoea and hypopnoea or apnoeas.…”