Title:Treatment of the Cheyne-Stokes Breathing Pattern in Patients with Congestive Heart Failure: An Update
Volume: 9
Issue: 2
Author(s): Jeanne Wallace and Charles Poon
Affiliation:
Keywords:
Cheyne-Stokes breathing, heart failure, central sleep apnea, periodic breathing, adaptive seroventilation.
Abstract: Cheyne-Stokes breathing/central sleep apnea (CSB/CSA) commonly occurs in patients with congestive heart
failure. Since our previous review, there has been further evidence supporting the clinical significance of this primarily
nocturnal breathing disorder in terms of the associated physiologic and biochemical changes that may lead to further
deterioration of cardiac function, as well as increased mortality. Suppression of CSB/CSA can be difficult to achieve and
a consistently effective therapeutic strategy has not been identified. Although optimizing medical management of the
underlying heart failure would be a logical initial intervention, lower prevalence of CSB/CSA has not been observed in
groups of patients receiving modern medical therapy. Recently published guidelines have supported nocturnal oxygen,
CPAP and adaptive servo-ventilation as standard recommendations for treatment. Further evidence since the last review
has backed pacemaker resynchronization as an effective means of suppressing CSB/CSA. Early studies on the feasibility
of phrenic nerve stimulation as a means for interrupting CSB/CSA period breathing have shown promise. Other methods
including positional therapy, carbon dioxide and acetazolamide have continued to show effect in attenuating CSB/CSA in
some patients. More recently, combination therapies, such as nocturnal oxygen and CPAP have been suggested as
alternative treatment approaches for CSB/CSA, but have not yet been validated by published evidence. The interaction
between HF and SDB are complex, and call for close collaboration between cardiologists and pulmonary specialists for
optimal care of patients with these disorders.
