Cheyne-Stokes respiration during sleep: a possible effect of body position

Cheyne-Stokes Respiration (CSR) is a common finding in Chronic Heart Failure and Stroke patients. The body position effect during sleep on obstructive breathing abnormalities is well known. However, the effect of body position during sleep on breathing abnormalities of central type like CSR has not been well documented. Six sleep studies (two complete Polysomnographic (PSG) evaluations and four Pulse Oximetry recordings (PO)), were carried out in a 57-year-old female patient with a recent Cerebro Vascular Accident (CVA who had both Obstructive Sleep Apnea (OSA) and CSR. The first PSG was carried out two months post-stroke and revealed a severe, continuous CSR pattern during Non Rapid Eye Movements (NREM) sleep (mainly with central apneas), and Obstructive Sleep Apnea (OSA) during Rapid Eye Movements (REM) sleep, independent of body position: Supine Respiratory Disturbance Index (SRDI) = 85.2 and Lateral RDI (LRDI) = 95.4. A second PSG was performed three months later after an overall clinical improvement and showed a complete disappearance of CSR during NREM sleep and OSA during REM sleep in her lateral posture (LRDI = 0), while the RDI in the supine posture was only slightly improved (SRDI = 73.2). The CSR pattern was less severe and was characterized mainly by central hypopneas. Two PO recordings between the PSG studies showed similar improvement trends. Two additional PO recordings, two and three weeks after the last PSG (the first one with the patient lying supine and the second one with the patient lying on her side throughout the night), revealed a further significant improvement in the supine posture (SRDI = 37.5). The results of this study suggest that body posture may play a role not only in the prevalence and severity of obstructive breathing disorders, but also in CSR, a central type of breathing abnormalities during sleep.