Cheyne-Stokes respiration classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Epidemiology and Demographics
Association with Congestive Heart Failure (CHF)
Although the incidence of CSR is unknown, it seems to be fairly common in patients with New York Heart Association (NYHA) class III and IV disease.
- One study found that 45% of patients with moderate, stable, optimally treated CHF had CSR with an apnea – hypopnea index (AHI) >20. These episodes were associated with a SaO2 < 90% for ¼ - ½ of total sleep time. The patients were also found to have a significant increase in the number of episodes of nocturnal ventricular arrhythmias.
- Another study found that although the cardiac parameters did not differ between patients, those with CHF and CSR has reduced total sleep time, reduced sleep efficiency, increased proportion of stages I, II, and NREM sleep and reduced REM sleep. By definition, they had higher AHIs, however the degree of hypoxemia during desaturation did not differ between the groups.
- The recurrent desaturations and arousals experienced by patients with CHF and CSR have been associated with an increase in nocturnal angina and ventricular arrhythmias. It has also been shown that these patients have higher circulating plasma norepinephrine levels, which can obviously worsen afterload and heart failure.
Association with Stroke
CSR was once thought only to occur with bilateral or large deeper strokes, however is now recognized to be much more common, and can be seen in patients with ischemic stroke in any location.
- One study identified CSR in 59% of patients with supratentorial stroke, and in 40% with infratentorial stroke. The patients with CSR had a significant decrease in SaO2 as compared to those without CSR, and the authors raised the concern for potential worsening of ischemia in the peri-infarct zone, due to low sats in these patients.