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Clinical Insights

Cheyne Stokes Syndrome diagnosed with a 3D oximeter

In the case of sleep apnea the desaturation has instead a single phase of prolonged and continuous descent to the point of minimum SpO2 while the subsequent ascent is short and steep because of the resumption of breathing.

Fig. 7 – Sleep oximetry: an example of an episode of desaturation due to sleep apnea (OSA).
Fig. 8 – Sleep oximetry: a sequence of desaturation caused by sleep apnea (OSA).

To ensure that oxygen gets to the cells, it is necessary that it goes through breathing from the atmosphere to the lungs alveoli through the upper airways and bronchi with a cyclic movement of the chest (ventilation ) .

This movement is controlled by the respiration centre of the brainstem and and mobilizes approximately 0.5 liters of air per breath at rest ( tidal volume ) for about 12 breaths per minute ( respiratory rate ) .

In a healthy subject at rest the breathing rhythm is very regular . Even in many obstructive respiratory diseases (asthma and COPD) or restrictive ( fibrosis ) in which you change the current volume the breathing rhythm is maintained regularly.

However, with periodic breathing there is an irregular rhythm even if periodic. The most popular model is the so-called Cheyne Stokes breathing , present in heart failure , probably due to the increase of the transit time of blood from the lungs to the Center of the Breath .

This model is characterized by the continuous repetition of periods of progressive decrease in tidal volume followed by a short period of apnea and an increase in tidal volume , as described above. This sequence is repeated with remarkable regularity.

Bibliography:

Olson EJ, Moore WR, Morgenthaler TI et al. Obstructive Sleep Apnea-Hypopnea Syndrome. Mayo Clin Proc. 2003; 78: 1545-52.

Mbata GC and Chukwuka JC. Obstructive Sleep Apnea Hypopnea Syndrome. Ann Med Health Sci Res. 2012; 2: 74–77.

Quaranta AJ, D’Alonzo GE, Krachman SL. Cheyne-Stokes respiration during sleep in congestive heart failure. Chest. 1997 ; 111(2): 467-73.

AlDabal L, BaHammam AS. Cheyne-stokes respiration in patients with heart failure. Lung. 2010; 188(1): 5-14.

Yumino D, Bradley TD. Central sleep apnea and Cheyne-Stokes respiration. Proc Am Thorac Soc. 2008 Feb 15;5(2):226-36.

Pino G, Milone PA, Ciappi G. Ipoventilazione alveolare e iposensibilità dei centri respiratori in un caso di sindrome diencefalica. Rassegna di Patologia dell’Apparato Respiratorio 1963-, 13 (4): 3-18.

Farré R, Montserrat JM, Navajas D. Noninvasive monitoring of respiratory mechanics during sleep. Eur Respir J. 2004; 24(6): 1052-60.

Gastaut H, Tassinari CA, Duron B.Polygraphic study of the episodic diurnal and nocturnal (hypnic and respiratory) manifestations of the Pickwick syndrome. Brain Res. 1966 ; 1(2): 167-86.

 

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