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Published ahead of print on January 21, 2005, doi:10.1164/rccm.200411-1591OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 9, May 2005, 1048-1052

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Submitted on November 29, 2004
Accepted on January 18, 2005

Cheyne-Stokes Respiration in Stroke: Relationship to Hypocapnia and Occult Cardiac Dysfunction

Cherdchai Nopmaneejumruslers1, Yasuyuki Kaneko1, Vlasta Hajek1, Vera Zivanovic1, and T. Douglas Bradley1*

1 Sleep Research Laboratory of the Toronto Rehabilitation Institute, Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, ON, Canada

* To whom correspondence should be addressed. E-mail: douglas.bradley{at}utoronto.ca.

BACKGROUND: Central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) have been reported in association with stroke, but their pathophysiological correlates have not been well described. OBJECTIVE: To test the hypotheses that: 1) CSA in stroke patients is associated with nocturnal hypocapnia, and 2) in those stroke patients with CSA and with left ventricular (LV)systolic dysfunction, periodic breathing (PB) will have a CSR pattern in which cycle duration is greater than in those without LV systolic dysfunction. METHODS: We prospectively performed polysomnography and echocardiography in 93 patients with stroke. CSA was defined as central apneas and hypopneas occurring at a rate of >10/hr of sleep. In patients with CSA, we compared PB cycle duration between those with normal and impaired LV systolic function (left ventricular ejection fraction [LVEF] >40% and ≤40%, respectively). RESULTS: CSA was found in 19% of subjects who had lower nocturnal transcutaneous PCO2(39.3±0.9 versus 42.8±0.8 mm Hg, P=0.015) and a higher prevalence of LVEF ≤40% (22 versus 5%, P=0.043) than stroke patients without CSA. There was no significant difference in stroke location or type between the two groups. In patients with CSA, those with LVEF ≤40% had a longer PB cycle than those with LVEF >40% (66.6±5.6 versus 46.6±2.9 sec, P=0.006), but had no symptoms of heart failure. CONCLUSIONS: In stroke patients, CSA is associated with hypocapnia and occult LV systolic dysfunction, but is not related to the location or type of stroke. The presence of LV systolic dysfunction is associated with a Cheyne-Stokes pattern of hyperpnea.
Key words: stroke, sleep apnea, Cheyne-Stokes respiration




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