The Mechanism of Cheyne-Stokes Respiration*

Lange, Ramon L.; Hecht, Hans H.

doi:10.1172/jci104465

Cited by 92 publications

(23 citation statements)

References 15 publications

(25 reference statements)

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“…They also noted that the increase in cardiac index during exercise was inversely related to the cycle length and amplitude of oscillating V E. The cycle length of oscillating V E possibly corresponds to circulation time. [23][24][25] In the present study, we found that cardiac patients with more impaired cardiopulmonary dysfunction during exercise, as reflected in the CPX indices, had a longer cycle length of oscillating V E. This finding supports the hypothesis by Murphy et al 23 that oscillatory breathing is an important surrogate for hemodynamic impairment in patients with heart failure. It is known that the oscillatory breathing noted at rest sometimes becomes unclear or even disappears during high-intensity exercise.…”

Section: Discussionsupporting

confidence: 91%

Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac Patients

Kato

Koike

Hoshimoto-Iwamoto

et al. 2013

Circ J

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Cardiopulmonary exercise testing (CPX) is a useful clinical tool for evaluating the severity of disease and the limitations of activities of daily life in cardiac patients. 9 As described by the Fick's equation, O2 uptake (V O2) is the product of cardiac output and the arteriovenous O2 difference. Among the parameters obtained from CPX, the peak V O2 is traditionally considered as the gold standard for identifying patients with a poor prognosis and selecting candidates for cardiac transplantation. 10 The slope of the increase in ventilation (V E) to the increase in CO2 output (V CO2) (V E-V CO2 slope) is also an established index reflecting cardiopulmonary dysfunction during exercise. 9 scillatory breathing, alternating between hyperpnea and hypopnea during sleep and commonly referred to as central sleep apnea or Cheyne-Stokes respiration, has long been recognized in cardiac patients. An instability of the ventilatory control system, 1 long circulation time, 2-4 high sensitivity of ventilation to changes in CO2, 5 a decrease in the PaCO2 regulatory set point, 5,6 or fluctuations in the pulmonary blood flow 7,8 have been proposed as possible mechanisms underlying this abnormal breathing. A similar breathing pattern has also been recognized during waking hours in cardiac patients, especially those with heart failure. The mechanisms underlying oscillatory breathing while awake are assumed to overlap, at least in part, with those of central sleep apnea. However, reports on the mechanisms of oscillatory breathing while awake are limited. The relation between the magnitude of oscillatory breathing while awake and the severity of heart failure has not Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac PatientsJo Kato, MD; Akira Koike, MD; Masayo Hoshimoto-Iwamoto, PhD; Osamu Nagayama, BSc; Koji Sakurada; Akira Sato, MD; Takeshi Yamashita, MD; Karlman Wasserman, MD, PhD; Kazutaka Aonuma, MD Background: Oscillatory breathing, alternating between hyperpnea and hypopnea, has been recognized in cardiac patients, especially in those with heart failure. We evaluated whether the cycle length and amplitude of oscillatory breathing correlate with impaired cardiopulmonary function during exercise.

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Section: Discussionsupporting

confidence: 91%

Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac Patients

Kato

Koike

Hoshimoto-Iwamoto

et al. 2013

Circ J

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“…This prediction is supported by the clinical observations in this study and those of others. 8 It is more appropriate than Mackey and Glass' prediction 24 of a ratio of 4. The clinically observed correlation between lungto-ear circulation time and the period of PB 14 is thus explained.…”

Section: The Importance Of Time Delaymentioning

confidence: 98%

“…[7][8][9][10] Clinical studies have identified several possibilities in patients with PB, 11,12 particularly hyperventilation or hypocapnia. 6,[13][14][15][16] Prolonged circulation delay 8,17 and increased chemoreceptor sensitivity 18 have also been implicated. The role of circulation delay is controversial, partly because of animal work 19 that had to prolong it to a biologically implausible 2 to 5 minutes to engender PB.…”

mentioning

confidence: 99%

Quantitative General Theory for Periodic Breathing in Chronic Heart Failure and its Clinical Implications

et al. 2000

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Background-In patients with chronic heart failure (CHF), periodic breathing (PB) predicts poor prognosis. Clinical studies have identified numerous risk factors for PB (which also includes Cheyne-Stokes respiration). Computer simulations have shown that oscillations can arise from delayed negative feedback. However, no simple general theory quantitatively explains PB and its mechanisms of treatment using widely-understood clinical concepts. Therefore, we introduce a new approach to the quantitative analysis of the dynamic physiology governing cardiorespiratory stability in CHF. Methods and Results-An algebraic formula was derived (presented as a simple 2D plot), enabling prediction from easily acquired clinical data to determine whether respiration will be unstable. Clinical validation was performed in 20 patients with CHF (10 with PB and 10 without) and 10 healthy normal subjects. Measurements, including chemoreflex sensitivity (S) and delay (␦), alveolar volume (V L ), and end-tidal CO 2 fraction (C ), were applied to the stability formula. The breathing pattern was correctly predicted in 28 of the 30 subjects. The principal combined parameter (C S)ϫ(␦/V L ) was higher in patients with PB (14.2Ϯ3.0) than in those without PB (3.1Ϯ0.5; Pϭ0.0005) or in normal controls (2.4Ϯ0.5; Pϭ0.0003). This was because of differences in both chemoreflex sensitivity (1749Ϯ235 versus 620Ϯ103 and 526Ϯ104 L/min per atm CO 2 ; Pϭ0.0001 and PϽ0.0001, respectively) and chemoreflex delay (0.53Ϯ0.06 vs 0.40Ϯ0.06 and 0.30Ϯ0.04 min; PϭNS and Pϭ0.02). Conclusion-This analytical approach identifies the physiological abnormalities that are important in the genesis of PB and explicitly defines the region of predicted instability. The clinical data identify chemoreflex gain and delay time (rather than hyperventilation or hypocapnia) as causes of PB.

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“…7 Clinically however, hypoxia occurs in a minority of cases, and administration of oxygen to correct any hypoxia does not affect the breathing pattern. 8,9 On the other hand, hypocarbia with respiratory alkalosis is consistently present, even during the apneic periods. 8 Respiratory alkalosis can lower blood pressure and may itself restrict cerebral and medullary blood flow, exacerbating inadequate circulation and perpetuating CSR.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 On the other hand, hypocarbia with respiratory alkalosis is consistently present, even during the apneic periods. 8 Respiratory alkalosis can lower blood pressure and may itself restrict cerebral and medullary blood flow, exacerbating inadequate circulation and perpetuating CSR. 9,10 Administration of carbon dioxide can correct the hypotension of respiratory alkalosis, restore cerebral blood flow, and reverse the periodic apnea and CSR.…”

Section: Discussionmentioning

confidence: 99%

Cheyne–Stokes respiration, periodic circulation, and pulsus alternans in spinal cord injury patients

Frisbie

Sharma

2005

Spinal Cord

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Study design: Case reports. Objectives: To describe Cheyne-Stokes respiration (CSR) and associated circulatory abnormalities in three patients with spinal cord lesions. Setting: Veterans Administration Hospital, USA. Subjects: One paraplegic patient with coronary artery disease in congestive heart failure, one tetraplegic patient with alcoholic cardiomyopathy and postural hypotension, and one tetraplegic complete patient with cardiomegaly, severe aortic atherosclerosis, and postural hypotension. Methods: Breathing activity was measured with a nasal thermistor or abdominal stretch transducer. Cardiac activity was estimated with a photoelectric sensor for cutaneous blood flow placed on the forehead or a piezoelectric transducer for pressure positioned over an artery or the cardiac apex. Tracings were drawn on a strip chart recorder. The subjects were at rest in semireclining positions. Results: Survey times were 17-21 min, and cycling periods were 41-72 s. Periodic changes in the depth of breathing were accompanied by periodic changes in amplitude of forehead cutaneous pulse, blood pressure, or apical cardiac impulse in all patients. Peak circulation occurred at or following peak respiration. In addition, cyclical pulsus alternans occurred in two patients. Conclusion: Three spinal cord injury patients sustained CSR and circulatory periodicity associated with cardiac disease and postural hypotension.Spinal Cord (2005) 43, 385-388.

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The Mechanism of Cheyne-Stokes Respiration*

Cited by 92 publications

References 15 publications

Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac Patients

Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac Patients

Quantitative General Theory for Periodic Breathing in Chronic Heart Failure and its Clinical Implications

Cheyne–Stokes respiration, periodic circulation, and pulsus alternans in spinal cord injury patients

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