Quaranta A J, D'Alonzo G E, Krachman S L
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, USA.
Chest. 1997 Feb;111(2):467-73. doi: 10.1378/chest.111.2.467.
Cheyne-Stokes respiration (CSR) is a form of sleep-disordered breathing seen in approximately 40% of congestive heart failure patients with a left ventricular ejection fraction of < 40%. It is characterized by a crescendo-decrescendo alteration in tidal volume separated by periods of apnea or hypopnea. Sleep is generally disrupted, often with frequent nocturnal arousals. Clinical features include excessive daytime sleepiness, paroxysmal nocturnal dyspnea, insomnia, and snoring. Proposed mechanisms include the following: (1) an increased CNS sensitivity to changes in arterial PCO2 and PO2 (increased central controller gain); (2) a decrease in total body stores of CO2 and O2 with resulting instability in arterial blood gas tensions in response to changes in ventilation (underdamping); and (3) an increased circulatory time. In addition, hyperventilation induced hypocapnia seems to be an important determinant for the development of CSR. Mortality appears to be increased in patients with CSR compared to control subjects with a similar degree of left ventricular dysfunction. Therapeutic options include medically maximizing cardiac function, nocturnal oxygen therapy, and nasal continuous positive airway pressure. The role that other therapeutic modalities, such as inhaled CO2 and acetazolamide, might have in the treatment of CSR associated with congestive heart failure has yet to be determined.
陈-施呼吸（CSR）是一种睡眠呼吸障碍形式，在左心室射血分数<40%的充血性心力衰竭患者中约40%可见。其特征为潮气量呈渐强-渐弱变化，中间间隔呼吸暂停或呼吸浅慢期。睡眠通常会受到干扰，常伴有频繁的夜间觉醒。临床特征包括日间过度嗜睡、阵发性夜间呼吸困难、失眠和打鼾。提出的机制如下：（1）中枢神经系统对动脉血二氧化碳分压（PCO2）和氧分压（PO2）变化的敏感性增加（中枢控制器增益增加）；（2）体内二氧化碳和氧气储备总量减少，导致通气变化时动脉血气张力不稳定（欠阻尼）；（3）循环时间延长。此外，过度通气引起的低碳酸血症似乎是CSR发生的一个重要决定因素。与左心室功能障碍程度相似的对照组相比，CSR患者的死亡率似乎有所增加。治疗选择包括最大程度地优化心脏功能、夜间氧疗和经鼻持续气道正压通气。其他治疗方式，如吸入二氧化碳和乙酰唑胺，在治疗与充血性心力衰竭相关的CSR中可能发挥的作用尚未确定。
