Cheyne-Stokes Respiration in Patients with Acute Ischaemic Stroke: Observations on Middle Cerebral Artery Blood Velocity Changes Using Transcranial Doppler Ultrasound

Abstract

Variation in middle cerebral artery blood velocity was observed in 8 patients with Cheyne-Stokes respiration following acute ischaemic stroke in the middle cerebral artery territory. The middle cerebral artery blood velocity was highest during the first half of the respiratory phase, and lowest in the first half of the apnoeic phase, the mean difference between the blood velocities in the apnoeic and respiratory phases being significant at the p < 0.01 level on the symptomatic and asymptomatic sides. The respiratory pattern should be taken into account when measuring cerebral blood velocity in patients with stroke. The possible effect of Cheyne-Stokes respiration on blood flow to ischaemic brain is discussed.

Central Periodic Breathing Observed on Hospital Admission Is Associated with an Adverse Prognosis in Conscious Acute Stroke Patients

“…Fluctuations in other haemodynamic variables, such as BP and pCO 2 , may have more effect on penumbral brain than oxygen [7, 21]. Normal brain arterioles dilate and constrict in response to surges and decreases pCO 2 and/or BP, but in acute stroke patients when cerebral autoregulation is impaired, it is possible that arterioles in and around the ischaemic brain tissue cannot autoregulate in response to changes in pCO 2 and BP [22]. Therefore, during hypercarbia, blood may be diverted to normal tissue (‘steal’), reducing CBF to the ischaemic penumbra, resulting in worse clinical outcomes.…”

Sleep and Stroke

“…insulin resistance), and inflammatory or oxidative changes (e.g., increased levels of C-reactive protein, tumor necrosis factor [TNF]-α, interleukin [IL]-6, adhesion molecules) result, contributing to diabetes, increased platelet aggregation, decreased fibrinolysis, endothelial damage, and atherogenesis. 81,85,86 Paradoxical embolization resulting from rightto-left shunting in patients with patent foramen ovale during long apneas is another potential mechanism of stroke. 74,75 The observation of an increase in the intima-media thickness of the common carotid artery documented by ultrasound techniques in SDB patients as compared with controls matched for age and vascular risk factors gives further support for an increased (chronic) atherogenesis in SDB.…”