Assessment of Cheyne-Stokes respiration using diaphragmatic ultrasonography.

This case explores Cheyne-Stokes respiration (CSR), a breathing pattern common in heart failure and brain injury patients. Using diaphragmatic ultrasound, the study assesses a 74-year-old patient with heart failure exhibiting CSR during sleep. Diaphragmatic excursion patterns reveal the characteristic crescendo-decrescendo pattern of CSR.

Respiración de Cheyne-Stokes en una adolescente con insuficiencia cardíaca secundaria a miocardiopatía dilatada que requirió trasplante cardíaco / Cheyne-Stokes respiration in an adolescent with heart failure secondary to dilated cardiomyopathy requiring heart transplantation

La respiración de Cheyne-Stokes es una variante cíclica o tipo de apnea central del sueño poco frecuente en la población pediátrica. Se describe a una paciente de 12 años con insuficiencia cardíaca grave relacionada con miocardiopatía dilatada que demostró trastornos del sueño con características de respiración de Cheyne-Stokes, que se resolvieron completamente después del trasplante cardíaco.

Cheyne-Stokes respiration is a cyclic variant or type of central sleep apnea rare in pediatric population. We describe a 12-year-old female patient with severe heart failure related to dilated cardiomyopathy who demonstrated sleep disorders with Cheyne-Stokes breathing features, which completely resolved following cardiac transplantation.

[Cheyne-Stokes respiration in an adolescent with heart failure secondary to dilated cardiomyopathy requiring heart transplantation]. / Respiración de Cheyne-Stokes en una adolescente con insuficiencia cardíaca secundaria a miocardiopatía dilatada que requirió trasplante cardíaco.

Cheyne-Stokes respiration is a cyclic variant or type of central sleep apnea rare in pediatric population. We describe a 12-yearold female patient with severe heart failure related to dilated cardiomyopathy who demonstrated sleep disorders with Cheyne-Stokes breathing features, which completely resolved following cardiac transplantation.

La respiración de Cheyne-Stokes es una variante cíclica o tipo de apnea central del sueño poco frecuente en la población pediátrica. Se describe a una paciente de 12 años con insuficiencia cardíaca grave relacionada con miocardiopatía dilatada que demostró trastornos del sueño con características de respiración de Cheyne-Stokes, que se resolvieron completamente después del trasplante cardíaco.

Characterization of the respiratory pattern in patients with chronic heart failure applying joint symbolic dynamics / Caracterización del patrón respiratorio de pacientes con insuficiencia cardíaca crónica mediante análisis de dinámica simbólica conjunta

Abstract: This work proposes a method to characterize the respiratory pattern of patients with chronic heart failure (CHF) to determine non-periodic breathing (nPB), periodic breathing (PB) and Cheyne-Stokes respiration (CSR) through non-linear, symbolic analysis of biological signals. A total of 43 patients were examined for their cardiorespiratory profiles, their ECG and respiratory pattern signals were processed, analyzed and studied for parameters that could be of potential use in clinical decision making, specifically in patient classification. Patients in the study were characterized through their cardiorespiratory signals, applying joint symbolic dynamics (JSD) analysis to cardiac beat and respiratory interval durations. The most statistically significant parameters across all groups were identified through a Kruskal-Wallis two tailed test (α = 0.05) and a linear discriminant analysis (LDA) classification method based on such parameters was developed. The best result achieved with this classification method uses 10 features to discriminate patients with a 97.67% Accuracy (Acc). The best features to discriminate among groups are related to cardiorespiratory interaction rather than just respiration patterns alone. Results further support the idea that abnormal breathing patterns derive from physiological abnormalities in chronic heart failure.

Resumen: El trabajo propone un método para identificar el patrón respiratorio de pacientes con insuficiencia cardiaca crónica (CHF) con la finalidad de determinar respiración no periódica (NPB), respiración periódica (PB) y respiración de Cheyne-Stokes (CSR) a través de análisis simbólico no lineal de señales biológicas. Se examinaron los perfiles cardiorrespiratorios de 43 pacientes; sus señales de ECG y patrón respiratorio fueron procesados, analizados y estudiados en busca de parámetros que pudieran ser de utilidad, específicamente en la clasificación de pacientes. Estos pacientes se caracterizaron por medio de sus señales cardiorrespiratorias, aplicando un análisis de dinámica simbólica de conjuntos al ritmo cardíaco y a la duración de los intervalos respiratorios. Los parámetros de mayor significancia estadística entre todos los grupos se identificaron a través de una prueba Kruskal-Wallis de dos colas ( α = 0,05) y mediante un método de clasificación por análisis discriminante lineal (LDA). El mejor resultado conseguido con este método utiliza 10 características para discriminar a los pacientes con una precisión de 97,67% (Acc). Las características para discriminar entre grupos estuvieron relacionados con la interacción cardiorrespiratoria más que con solo los patrones de respiración, respaldando así la idea de que los patrones de respiración anormales derivan de anomalías fisiológicas presentes en la insuficiencia cardíaca crónica.

Respiración de Cheyne-Stokes y bruxismo severo documentada por polisomnografía que mejora con la administración de oxígeno a 1 L/min / Cheyne-Stokes respiration and severe bruxism documented by polysomnography that improves with administration of oxygen at 1 L/min

Se presenta el caso de una mujer de 59 años con diagnóstico de encefalopatía anoxicoisquémica, quien se encuentra en estado vegetativo persistente y epilepsia secundaria de difícil control, quien en el transcurso de su evolución clínica desarrolla apnea central del sueño con índice de apnea hipopnea (IAH) de 87.86/h con patrón de respiración de Cheyne-Stokes (RCS) y bruxismo severo documentado mediante polisomnografía, alteraciones que mejoraron tras la administración de oxígeno por cánula nasal a 1 L/min. La asociación de bruxismo con respiración de Cheyne-Stokes y la respuesta simultánea y completa de las dos alteraciones a la administración de oxígeno suplementario no ha sido reportada previamente.

The case of a 59 year old female diagnosed with anoxic-ischemic encephalopathy, who is in a persistent vegetative state and secondary epilepsy difficult to control, who in the course of her clinical evolution develops central sleep apnea with apnea hypopnea index (AHI) of 87.86 / h with Cheyne-Stokes pattern and severe bruxism documented by polysomnography, alterations that improved after administration of oxygen by nasal cannula at 1 L / min., is presented. The association of bruxism with Cheyne-Stokes respiration and the simultaneous and complete response of the two alterations to the administration of supplemental oxygen has not been reported previously.

Breathing disorders in congestive heart failure: gender, etiology and mortality

We investigated the relationship between sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) while awake as well as mortality. Eighty-nine consecutive outpatients (29 females) with congestive heart failure (CHF; left ventricular ejection fraction, LVEF <45 percent) were prospectively evaluated. The presence of SDB and of CSR while awake before sleep onset was investigated by polysomnography. SDB prevalence was 81 and 56 percent, using apnea-hypopnea index cutoffs >5 and >15, respectively. CHF etiologies were similar according to the prevalence of SDB and sleep pattern. Males and females were similar in age, body mass index, and LVEF. Males presented more SDB (P = 0.01), higher apnea-hypopnea index (P = 0.04), more light sleep (stages 1 and 2; P < 0.05), and less deep sleep (P < 0.001) than females. During follow-up (25 ± 10 months), 27 percent of the population died. Non-survivors had lower LVEF (P = 0.01), worse New York Heart Association (NYHA) functional classification (P = 0.03), and higher CSR while awake (P < 0.001) than survivors. As determined by Cox proportional model, NYHA class IV (RR = 3.95, 95 percentCI = 1.37-11.38, P = 0.011) and CSR while awake with a marginal significance (RR = 2.96, 95 percentCI = 0.94-9.33, P = 0.064) were associated with mortality. In conclusion, the prevalence of SDB and sleep pattern of patients with Chagas' disease were similar to that of patients with CHF due to other etiologies. Males presented more frequent and more severe SDB and worse sleep quality than females. The presence of CSR while awake, but not during sleep, may be associated with a poor prognosis in patients with CHF.