Cheyne-Stokes treatment: Overview of treating Cheyne-Stokes breathing

Cheyne-Stokes treatment options: How do they differ from treatments of sleep apnea? Since understanding the recommended methods of treating Cheyne-Stokes breathing helps us better understand this condition, as well as its connection to sleep apnea, we explore the treatments for Cheyne-Stokes breathing.

Cheyne-Stokes breathing is a health condition that causes breathing to behave abnormally, usually (but not always) during sleep. It also involves apneas, or pauses in breathing, which are also characteristic of sleep apnea. And that can blur the line between the two conditions.

As if that wasn’t enough to make diagnosis and treatment difficult, a prime characteristic of Cheyne-Stokes breathing is the presence of other conditions like heart failure. With all this in mind, what do experts recommend for Cheyne-Stokes treatment?

“Generally, patients with Cheyne-Stokes respiration sufficient to cause symptoms have more than 20 apnoeas and hypopnoeas per hour sleep and should be considered for treatment,” advise the authors of a study in Thorax.¹ They goes on to divide recommended Cheyne-Stokes treatment options into five broad groups. We explore each of these options in greater detail below.

Cheyne-Stokes treatment: Intensive heart failure treatment

The authors suggest that most patients diagnosed with Cheyne-Stokes breathing would already be on “optimal medical treatment for congestive heart failure, and as a result the severity of Cheyne-Stokes respiration would diminish.”

Cheyne-Stokes treatment: Respiratory stimulants

Noting that theophylline, carbon dioxide and acetazolamide are three respiratory stimulants that have been used to treat Cheyne-Stokes breathing, the authors do warn that “they should be used with great caution.” The reason? Extensive testing wasn’t yet completed at the time they published their study, and there were suggestions of unwelcome side effects.

“Hence, at the present time there is little evidence in favour of the use of respiratory stimulants in Cheyne-Stokes respiration,” the authors write. “Moreover, since patients with congestive heart failure who have Cheyne-Stokes respiration are already hyperventilating and have weak respiratory muscles, there is no strong rationale for the use of these drugs in the chronic treatment of this disorder.”

Cheyne-Stokes treatment: Respiratory depressants

The authors flatly state their doubts about this Cheyne-Stokes treatment option, saying that various attempts “failed to reduce the frequency” of central sleep apnea occurrences.

Cheyne-Stokes treatment: Oxygen

Providing oxygen to patients with Cheyne-Stokes breathing seems to be effective; the authors write that it seems to allow patents “to rise above the [apnea] threshold,” citing one study in which a doctor “observed a significant fall in Cheyne-Stokes respiration … with treatment for a single night of … intranasal oxygen.” However, they also mention that some experts have warned that supplemental oxygen can potentially cause obstructive sleep apnea.

Cheyne-Stokes treatment: Continuous positive airway pressure (CPAP)

Finally, the authors talk about the “beneficial short term effects” of continuous positive airway pressure (CPAP) – a treatment option that’s very familiar to sleep apnea patients. They cite a number of studies supporting this statement.

But it’s not their top choice: “There is controversy as to the effectiveness of CPAP for the treatment of congestive heart failure and Cheyne-Stokes respiration,” they add, citing some studies that came up short on positive results.

So, what’s the takeaway? Based upon current evidence, the Thorax authors recommend “medical therapy directed at congestive heart failure, followed by CPAP (commenced gradually under supervision) and/or supplemental oxygen” adding that “respiratory stimulants or suppressants” in Cheyne-Stokes treatment “needs further study.”