Don D. Sin, MD, MPH; T. Douglas Bradley, MD
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Sin DD, Bradley TD. Theophylline Therapy for Near-Fatal Cheyne-Stokes Respiration. Ann Intern Med. 1999;131:713. doi: 10.7326/0003-4819-131-9-199911020-00018
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Published: Ann Intern Med. 1999;131(9):713.
TO THE EDITOR:
Pesek and colleagues (1) described abolition of near-fatal Cheyne-Stokes respiration by theophylline therapy. However, we believe that the use of the term “Cheyne-Stokes respiration” to describe their patient's respiratory disorder was not consistent with the known pathophysiology and clinical description of this term. Thus, the authors' findings are difficult to interpret.
As the authors note, Cheyne-Stokes respiration is characterized by periodic breathing in which apneas or hypopneas alternate with hyperventilation, occurring in a crescendo-decrescendo pattern of tidal volume (1). However, this pattern of respiration was not apparent in the figures that were presented. Moreover, the patient had hypercapnia while breathing room air (PCO2, 60 mm Hg) during these respiratory events. This is not consistent with Cheyne-Stokes respiration, which is associated with hypocapnia, not hypercapnia (2). Indeed, hyperventilation, precipitating a decrease in PCO2 below the apneic threshold, is the key physiologic feature of Cheyne-Stokes respiration (2, 3). In addition, the patient had diabetic neuropathy but no evidence of heart failure. Cheyne-Stokes respiration usually occurs in patients with heart failure who have augmented chemosensitivity to CO2 and increased circulation time (4). Because diabetic patients with neuropathy are predisposed to blunted chemosensitivity (1), they are at increased risk for central alveolar hypoventilation syndromes but not for Cheyne-Stokes respiration.
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