Cheyne-Stokes and Abnormal Patterns of Respiration

Also known as periodic respiration with cycles of respiration that are increasingly deeper then shallower with possible periods of apnoea. Typically, over a period of 1 minute, a 10-20 second episode of apnoea or hypopnoea is observed followed by respirations of increasing depth and frequency¹. The cycle then repeats itself.

• Patients with Cheyne-Stokes respiration usually present with the symptoms of orthopnoea, paroxysmal nocturnal dyspnoea, excessive daytime sleepiness and witnessed apnoeas in the setting of congestive heart failure².
• Cheyne-Stokes respiration is often a poor prognostic sign. However it may also be present as a normal finding in children, in healthy adults following fast ascending to great altitudes, or in sleep.
• Causes include:
  • Brainstem lesions: stroke
  • Encephalitis
  • Raised intracranial pressure
  • Heart failure
  • Chronic pulmonary oedema
  • Altitude sickness
• Management includes medical therapy directed at congestive heart failure, CPAP and/or supplemental oxygen².

• Acute dyspnoea causing the patient to awake from sleep and then sit upright or stand out of bed for relief.
• Associated with pulmonary oedema due to left ventricular failure (e.g. due to mitral stenosis, aortic insufficiency or hypertension) but nocturnal attacks of bronchial asthma may be difficult to differentiate.
• Paroxysmal nocturnal dyspnoea results from increased left ventricular filling pressures due to nocturnal fluid redistribution and enhanced renal reabsorption and therefore has a greater sensitivity and predictive value than dyspnoea.

Kussmaul breathing is deep sighing respiration associated with metabolic acidosis, e.g. diabetic ketoacidosis, renal failure.

Acute dyspnea occurring in terminal stages of exsanguinating hemorrhage. It is a grave sign and indicates the need for immediate transfusion.

Overbreathing may cause dizziness, lightheadedness, weakness, unsteadiness, muscle spasms in the hands and feet, and tingling around the mouth and fingertips. Abnormally low levels of carbon dioxide in the blood caused by overbreathing.
Causes include:

• Anxiety
• Head injury
• Stroke (pontine lesions) - breathing noisy
• Inappropriate use of stimulant drugs, excessive intake of aspirin