Skobel E, Kaminski R, Breuer C, Töpper R, Reffelmann T, Schwarz E R
Medizinische Klinik I, RWTH Aachen.
Med Klin (Munich). 2000 Dec 15;95(12):706-11. doi: 10.1007/pl00002090.
Cheyne-Stokes respiration is characterized by recurrent phases of central apneas during sleep alternating with a crescendo-decrescendo hyperventilation. This abnormal respiratory pattern is often observed in patients with severe congestive heart failure and associated with fragmentation of sleep, excessive daytime sleepiness, and a relatively high mortality. Increased peripheral and central chemosensitivity, prolonged circulation time, and reduced blood gas buffering capacity are the major factors contributing to the pathology. However, the exact pathophysiologic mechanisms are not clear yet. Respiratory stimulants, oxygen and continuous or bilevel positive airway pressure (CPAP or BiPAP) might reduce the severity of Cheyne-Stokes respiration but have little effect on daytime sleepiness and cardiac function. There is only limited data supporting the assumption that intensive heart failure therapy has an effect on Cheyne-Stokes respiration.
A 55-year-old male patient with dilative cardiomyopathy (NYHA IV) suffered excessive daytime sleepiness (Epworth Sleepiness Scale: 24 points). The patient was a heavy snorer with a normal body mass index. Treatment was initiated including ACE-inhibitors, beta-receptor blockers, diuretics and digoxin. The patient underwent sleep analysis with a Somno-Check system which demonstrated Cheyne-Stokes breathing (Respiratory Disturbance Index RDI: 40/h, lowest desaturation 76%) and body position dependent snoring. Oxygen therapy (21/min) had no effect on daytime sleepiness. Due to the cardiac condition, the patient was accepted for heart transplantation. Three weeks after transplantation sleep analysis was repeated and demonstrated a lack of evidence for periodic breathing (RDI 1/h, no desaturations below 90%), while snoring remained unchanged. Daytime sleepiness improved significantly (Epworth Sleepiness Scale: 6 points). Three weeks after normalizing left ventricular function a complete recovery from severe Cheyne-Stokes respiration was observed.
Adequate therapy of the underlying cause of Cheyne-Stokes breathing such as end-stage congestive heart failure might sufficiently abolish any breathing abnormalities.
潮式呼吸的特征是睡眠期间反复出现中枢性呼吸暂停阶段，与渐强-渐弱的通气过度交替出现。这种异常呼吸模式常在严重充血性心力衰竭患者中观察到，并与睡眠片段化、日间过度嗜睡及相对较高的死亡率相关。外周和中枢化学敏感性增加、循环时间延长及血气缓冲能力降低是导致该病理状态的主要因素。然而，确切的病理生理机制尚不清楚。呼吸兴奋剂、氧气以及持续气道正压通气或双水平气道正压通气（CPAP或BiPAP）可能会减轻潮式呼吸的严重程度，但对日间嗜睡和心功能影响甚微。仅有有限的数据支持强化心力衰竭治疗对潮式呼吸有影响这一假设。
一名55岁男性扩张型心肌病患者（纽约心脏协会心功能分级IV级）出现日间过度嗜睡（爱泼华嗜睡量表评分：24分）。该患者是重度打鼾者，体重指数正常。开始给予包括血管紧张素转换酶抑制剂、β受体阻滞剂、利尿剂和地高辛在内的治疗。患者使用Somno-Check系统进行睡眠分析，结果显示存在潮式呼吸（呼吸紊乱指数RDI：40次/小时，最低血氧饱和度76%）及体位依赖性打鼾。氧疗（2升/分钟）对日间嗜睡无影响。由于心脏状况，该患者被列入心脏移植名单。移植后三周重复进行睡眠分析，结果显示无周期性呼吸证据（RDI 1次/小时，无血氧饱和度低于90%的情况），而打鼾情况未改变。日间嗜睡明显改善（爱泼华嗜睡量表评分：6分）。左心室功能恢复正常三周后，观察到严重潮式呼吸完全恢复。
对潮式呼吸的潜在病因如终末期充血性心力衰竭进行充分治疗，可能足以消除所有呼吸异常。
