[Cheyne-Stokes breathing disorder in patients with congestive heart failure: incidence, pathophysiology, treatment and prognosis]

Abstract

Cheyne-Stokes Respiration (CSR) is a breathing disorder characterized by recurrent central sleep apneas, mainly during sleep, alternating with a crescendo-decrescendo pattern of tidal volume. The pathophysiology of CSR, which involves both the cardiovascular system, the pulmonary system and the sympathetic nervous system, is still not well understood. Although it is well recognized that congestive heart failure (CHF) patients suffer from CSR, only in recent years have studies been undertaken in order to determine the prevalence of this phenomenon and its implications regarding the patients life expectancy and quality. In a few studies it was found that 50% of moderate to severe CHF patients suffer significant CSR and other studies suggested that CSR has a negative prognostic value upon CHF patients. In order to treat CSR, novel therapeutic approaches have been tried, including oxygen delivery during the night, various pharmacological treatments aiming to stabilize the ventilatory system and other pharmacological treatments aiming to improve the ejection fraction of the left ventricle. However, none of these treatments has proved to be adequately efficient. This review tries to summarize current knowledge regarding CSR pathophysiology, prevalence, prognostic implications and current available treatments.