Upper Airway Occlusion during Sleep in Patients with Cheyne-Stokes Respiration^1–4

Abstract

Sleep-induced periodic breathing has been suggested to lead to the development of occlusive apneas in patients with sleep apnea syndrome. If this were true, patients with Cheyne-Stokes respiration should also develop upper airway occlusion during sleep. To study this hypothesis, 6 nonobese patients with Cheyne-Stokes respiration lacking evidence for sleep apnea syndrome and anatomic upper airway abnormalities underwent polysomnography during daytime naps. A total of 463 apneas were analyzed in the 6 patients studied. In 1 patient, no evidence of upper airway occlusion was observed. In the remaining 5 patients, a varying frequency of upper airway occlusion resembling the pattern of mixed apnea was seen in 3 to 97% of the total apneas analyzed. The mean number (+/- 1 SD) of occluded inspiratory efforts per mixed apnea in these 5 patients was 1.69 +/- 0.59. These results show that patients with Cheyne-Stokes respiration may develop upper airway occlusion during sleep and are consistent with the contention that sleep-induced periodic breathing in patients with sleep apnea syndrome is primary to the development of occlusive apneas.

Sleep Apnea and Heart Failure

“…For example, periodic oscillations in ventilatory drive related to CheyneStokes respiration may cause withdrawal of pharyngeal dilator muscle tone during the waning of ventilation, predisposing to upper airway narrowing or collapse. 34 In the recumbent position, fluid from the legs shifts to more central structures.…”

Cheyne-Stokes Respiration in Patients With Congestive Heart Failure: Causes and Consequences

“…If upper airway resistance increases as ventilation decreases during the decrescendo phase of the hyperpneic portion of Cheyne-Stokes respiration, there will be a tendency to cause an undershoot of ventilation. 60 The occasional occluded breath at the onset of central apnea during Cheyne-Stokes 59 is compatible with this possibility. On the other hand, decreasing resistance as ventilation increases during the crescendo phase will facilitate overshoot, rapidly driving PaCO 2 down and setting up conditions for posthyperventilation apnea.…”

“…Alex et al 59 described upper airway occlusion at the onset and at the end of central apnea in patients with CHF. Instability of upper airway resistance could promote the development of respiratory instability.…”

Evaluation of upper airway patency during Cheyne–Stokes breathing in heart failure patients

“…Upper airway closure has previously been reported to occur in some forms of both spontaneous and experimentally induced central apnoea [7,[12][13][14][15].…”

“…A key factor triggering central apnoeas is a reduction in carbon dioxide tension below the apnoea threshold [1], which is related to sleepwake instability, altered ventilatory and cerebrovascular carbon dioxide chemosensitivity, prolonged circulation time and stimulation from pulmonary irritant receptors [1,[4][5][6]. However, the observation that there may be a shift between obstructive and central apnoeas in CSR-CHF [7,8], that CSR can be affected by posture, [9,10] and that it may be suppressed by continuous positive airway pressure (CPAP) in some patients [11] suggests that upper airway instability may also play a role in this disorder. Dynamic changes in upper airway calibre might, therefore, be a further factor contributing to ventilatory instability in CSR-CHF.…”