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Cheyne-stokes respiration in children with heart failure

Jagdev Singh1, Katrina Zaballa2, Harvey Kok3

  • 1Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.

Paediatric Respiratory Reviews
|April 23, 2022
PubMed

Insights

Cheyne-Stokes respiration (CSA-CSR) is a central sleep apnea often seen in heart failure patients. This paper reviews its prevalence, treatment, and outcomes in children, highlighting the need for more research.

Area of Science:

  • Pediatric Sleep Medicine
  • Cardiorespiratory Physiology

Background:

  • Cheyne-Stokes respiration (CSA-CSR) is a central sleep apnea linked to cardiac insult and sympathetic overactivity.
  • It involves hyperventilation, reduced blood gas buffering, and circulatory delay, affecting 25-50% of adult heart failure patients.
  • CSA-CSR in heart failure is a poor prognostic indicator, but its pediatric data is scarce.

Purpose of the Study:

  • To discuss the prevalence, treatment options, and outcomes of CSA-CSR in children.
  • To highlight the under-recognition and under-diagnosis of CSA-CSR in pediatric heart failure.
  • To propose future research directions in pediatric sleep medicine regarding CSA-CSR.

Main Methods:

  • Review of existing literature on CSA-CSR in pediatric populations.
  • Synthesis of adult sleep medicine experience applied to pediatric cases.
  • Discussion based on limited case experience from a pediatric quaternary center.

Main Results:

  • Prevalence, progression, and treatment outcomes of pediatric CSA-CSR are largely unclear.
  • Only 11 pediatric cases of CSA-CSR have been described in the literature.
  • Under-recognition may stem from a lack of routine polysomnography in pediatric heart failure.

Conclusions:

  • There is a significant knowledge gap regarding CSA-CSR in children with heart failure.
  • Routine polysomnography may improve recognition and diagnosis in this vulnerable pediatric group.
  • Further research is crucial to understand and manage pediatric CSA-CSR effectively.

Keywords:
Adaptive servo ventilation (ASV)Bilevel positive airway pressure (BPAP)Central apneaCheyne-Stokes respirationContinuous positive airway pressure (CPAP)Crescendo-decrescendo breathing patternHeart failure

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