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Signs and Symptoms in Psychiatry
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
Cheyne-Stokes respiration: repeated cycles of abnormal breathing that are characterized by a gradual increase in depth of breathing, followed by gradual decrease, that ends by a period of apnea where breathing temporarily stops. It occurs in cases with bilateral hemispheric lesions, increased intracranial pressure, and in patients with heart or renal failure.
Sleep-related breathing disorders
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
Cheyne–Stokes respiration is mostly seen in individuals with left heart failure and, in such cases, this type of respiration is associated with worse prognosis [95]. Cheyne–Stokes respiration reflects the central respiratory instability which is associated to fluctuations in PaCO2 secondary to ventilation changes. The pulmonary venous congestion observed in congestive heart failure also generates vagal-mediated hyperventilation [96].
Patty
Published in Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner, The Integrated Nervous System, 2017
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner
Cheyne–Stokes respiration – This pattern consists of a fairly rhythmic oscillation between regular, deep breathing to a maximum amplitude peak followed by an equally gradual decrease in depth to the point where breathing is almost imperceptible. The cycle then repeats itself. This breathing pattern in a comatose individual, named after the physicians who originally described it, usually points to the presence of bilateral cerebral hemispheric pathology, whether structural or metabolic in type. A Cheyne–Stokes breathing pattern can also be seen in someone with a large middle cerebral artery (MCA) territory stroke or in the presence of severe congestive heart failure.
Sleep disorders and the risk of stroke
Published in Expert Review of Neurotherapeutics, 2018
Mollie McDermott, Devin L. Brown, Ronald D. Chervin
Fewer studies have investigated the association between central sleep apnea (CSA) and incident stroke. CSA is associated with incident atrial fibrillation, an important risk factor for ischemic stroke [22]. A prospective cohort study in Spain followed 394 subjects aged ≥70 years with baseline PSG and without previous stroke for a median of 6 years [6]. During this period, 20 incident ischemic strokes were observed. Whereas the obstructive apnea index was not associated with incident ischemic stroke, the central apnea index (CAI) was higher in subjects with incident ischemic stroke (mean CAI 9.48 versus 2.60, p = 0.014). After adjustment for atrial fibrillation and sex, CAI ≥3 was associated with three times the risk of incident ischemic stroke (aHR 3.08; 95% CI, 1.3–7.5). However, it should be noted that a CAI ≥5 is used as the threshold in many sleep laboratories. Furthermore, the authors did not describe how many subjects had Cheyne-Stokes respiration with CSA, a breathing pattern commonly observed in individuals with heart failure.
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
Cheyne-Stokes Respiration (CSR) is a sleep disorder breathing pattern involving cycles of hyperventilation that increase and decrease in intensity leading to apnea, as breathing efforts are suspended due to decreased ventilatory drive when PaCO2 falls below the apneustic threshold.79 CSR has a particularly high prevalence (50–75%) in congestive heart failure, likely due to the destabilizing effects of chronic hyperventilation, increased chemoreceptor sensitivity, and increased circulatory delay.79 CSR can also be seen in stroke patients and will clinically appear immediately after onset of stroke and improve with time.80,81 However, it does not indicate the anatomical location of the stroke.80 There is controversy surrounding the size of the affected area or the type of stroke, as it was thought that CSR is found in more extensive cerebral lesions with worse prognosis, and is more common in hemorrhagic strokes than in ischemic infarctions.80,81 The respiratory syndrome has also been described in transient ischemic attacks and lacunar infarctions (20.6%), which therefore cannot be ruled out when establishing the diagnosis.80,82 It is also possible that the presence of underlying cardiovascular and cerebrovascular factors, such as previous neurologic deficits, low LVEF, and left atrium enlargement, contribute more to the pathophysiology of CSR in stroke patients than the stroke itself.81 CSR can only be identified with sleep studies and may be routinely recommended for stroke patients.81
Obstructive sleep apnea and cardiovascular events in elderly patients
Published in Expert Review of Respiratory Medicine, 2022
Pablo Catalan Serra, Xavier Soler
Severe OSA increases the risk of heart failure in middle-aged patients. CSA and Cheyne-Stokes respiration increase the risk of heart failure in older patients. However, the risk of HF in OSA does not increase in older patients. A greater discrepancy exists in the results reported on the association between OSA and the incidence of CHD. Cardiovascular mortality increases with severity of OSA but, interestingly, decreases with age. Studies conducted on large cohorts of elderly patients found that CHD incidence does not increase significantly with age. CPAP treatment reduces the incidence of new cardiovascular events and cardiovascular mortality. However, few studies have been conducted in the elderly population, and most are observational.