Patty
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
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.
Exercise testing patients with cardiovascular disease
Robert B. Schoene, H. Thomas Robertson in Making Sense of Exercise Testing, 2018
A third, more recently accepted exercise ventilation risk factor relevant for the most severely impaired heart failure patients is the Cheyne–Stokes breathing pattern described above. Patients presenting with this periodic breathing abnormality during exercise have the same prognosis as a patient with New York Heart Association class IV symptoms. The exercise prognostic finding adds to risk assessment from the max measurement and is helpful if the periodic breathing persists throughout the CPET, making an appropriate estimate of the slope challenging.
C
Anton Sebastian in A Dictionary of the History of Medicine, 2018
Cheyne, John (1777–1836) Physician from Dublin and the son of a surgeon, who entered Edinburgh University at the age of 15 years. He studied anatomy with Charles Bell (1774–1842), and wrote his first book Essays on the Diseases of Children in 1801. He wrote an early monograph on laryngology, Pathology of the Membrane of the Larynx and Bronchia in 1809. He described acute hydrocephalus in 1808, and Cheyne-Stokes breathing, which occurred in apoplexy or stroke, in 1818. See Cheyne-Stokes breathing.
Developments in treating the nonmotor symptoms of stroke
Published in Expert Review of Neurotherapeutics, 2020
Sleep‐disordered Breathing is the most common sleep disorder after stroke and includes obstructive sleep apnea (OSA) and central sleep apnea (CSA). The latter resembles Cheyne–Stokes breathing. Sleep-disordered breathing is characterized by night‐time symptoms of excess respiratory noises such as snoring, irregular breathing, sleep-onset insomnia, shortness of breath, palpitations, nocturia, agitated sleep and daytime symptoms of sleepiness, headaches, and impaired concentration and memory [85]. OSA can contribute to post-stroke fatigue. Risk factors for the development of OSA and CSA include central obesity, increased age, male sex, and neck circumference [85]. These disorders are diagnosed with polysomnography. CSA is most common after bilateral strokes, strokes associated with disturbed levels of consciousness, or strokes accompanied by heart failure [40].
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