Cerebral circulation and function in Cheyne-Stokes respiration

Abstract

Phasic alterations of cerebral circulation were studied in seventeen patients with Cheyne-Stokes breathing associated with cardiovascular disease, cerebrovascular disease or the obesity cardiorespiratory syndrome. During the hyperpneic phase of respiration, the arterial oxygen saturation was lowest, and the carbon dioxide tension highest, at which time the cerebral arteriovenous oxygen difference was decreased. The converse changes appeared in apnea. An increase in spinal fluid pressure was noted in hyperpnea and a reduction in the circulation time across the brain was also observed. Electroencephalographic abnormalities frequently disappeared during hyperpnea along with improvement in the patient's mental function and consciousness. On the basis of these observations, it is postulated that cyclic alterations in cerebral circulation appear in Cheyne-Stokes respiration with an increased blood flow during hyperpnea and a decreased blood flow in apnea. It appears likely that the phasic alteration in cerebral circulation is the primary factor producing fluctuations in the patient's mental state, electroencephalogram and neurologic signs. It is equally possible, however, that the varying blood flow represents one more manifestation of phasic activity in the central nervous system which may be the basic cause of the syndrome of Cheyne-Stokes respiration.