Cheyne-Stokes respiration: pathological and non-pathological characteristics and causes

By Cristiano Antonino Last updated Jul 8, 2022

Cheyne-Stokes breathing (or periodic breathing) refers to a form of pathological breathing common in the elderly in which even long apnoea phases (up to 20 seconds) alternate with phases in which there is a gradual transition from deep breathing to increasingly shallow breathing (short, frequent breathing cycles) that ends again in the apnoea phase

Each abnormal breathing cycle lasts from a minimum of 45 seconds to a maximum of 3 minutes.

This loop can be prolonged several times.

The name of this pathological breathing comes from two doctors: John Cheyne and William Stokes who described the morbid condition in the 1800s.

Pathological causes of Cheyne-Stokes Breathing:

encephalopathies;
heart failure and other cardiopathies (40% prevalence);
intoxication by narcotics or hypnotics;
hypocapnia and hypoxaemia;
increased responsiveness of central and peripheral chemoreceptors;
airway damage;
prolonged circulation time;
reduced O2 reserve;
alternation of sleep phases and repetition of arousals;
mesencephalic syndrome coma;
respiratory diseases.

Fluctuations in ventilation lead to these clinical consequences:

oxyhaemoglobin desaturation;
retention of CO2;
haemodynamic changes;
activation of respiratory centres;
frequent conscious or unconscious micro-awakenings leading to sleep fragmentation;
insomnia and thus excessive daytime sleepiness;

These pathophysiological events act as a positive feedback worsening the syndrome itself, which is therefore self-maintained thanks to this vicious circle.

Non-pathological causes of Cheyne-Stokes Breathing:

In the elderly, it can occur – especially during sleep at night – even without any apparent pathology; moreover, it tends to appear when the subject stays at high altitudes.