Treatment of the Cheyne-Stokes Breathing Pattern in Patients with Congestive Heart Failure: State of the Art

Cheyne-Stokes breathing/central sleep apnea (CSB/CSA) commonly occurs in patients with congestive heart failure. Although the clinical significance of this primarily nocturnal breathing disorder is not certain, several studies have reported an association with increased mortality, as well as physiologic and biochemical changes that may lead to further deterioration of cardiac function. Suppression of CSB/CSA can be difficult to achieve and a consistently effective therapeutic strategy has not been identified. Optimizing medical management of the underlying heart failure is a logical initial intervention. In addition, positional therapy, oxygen, carbon dioxide, acetazolamide and theophylline have been associated with improvement of CSB/CSA in some patients. For patients with persistent CSB/CSA, nocturnal application of intrathoracic positive pressure via CPAP and BIPAP has sometimes been successful in attenuating CSB/CSA, but may not improve long-term survival. A newer technique, adaptive servo-ventilation that applies dynamic positive inspiratory pressure support in coordination with the patient's breathing pattern is promising, but more experience is needed to define the efficacy for attenuating CSB/CSA and long-term beneficial effects.