What are the different types of pathological breathing patterns?

From the Guidelines

Pathological breathing patterns are abnormal respiratory rhythms that indicate underlying medical conditions affecting the respiratory system or neurological control of breathing, and the main types include Kussmaul breathing, Cheyne-Stokes respiration, Biot's breathing, ataxic breathing, apneustic breathing, cluster breathing, and agonal breathing. The different types of pathological breathing patterns can be identified based on their characteristics, such as rate, depth, and regularity of breaths.

• Kussmaul breathing is characterized by deep, rapid respirations often seen in diabetic ketoacidosis and metabolic acidosis as the body attempts to eliminate excess carbon dioxide 1.
• Cheyne-Stokes respiration presents as a crescendo-decrescendo pattern with periods of apnea, commonly associated with heart failure, stroke, or brain injury due to delayed feedback in respiratory centers 1.
• Biot's breathing features irregular deep breaths followed by abrupt pauses, typically indicating increased intracranial pressure or severe brain damage.
• Ataxic breathing is completely irregular in rate and depth, suggesting lower brainstem dysfunction.
• Apneustic breathing involves prolonged inspiratory gasps with brief expiratory phases, indicating pontine lesions.
• Cluster breathing shows clusters of irregular breaths followed by periods of apnea, often signaling midbrain damage.
• Agonal breathing appears as slow, shallow, irregular gasps occurring pre-terminally. Obstructive patterns include stridor (high-pitched inspiratory sound from upper airway obstruction) and stertor (low-pitched snoring from partial upper airway obstruction) 1. Recognition of these patterns helps clinicians quickly identify potentially life-threatening conditions requiring immediate intervention, and the most recent and highest quality study on this topic is from 2018, which provides an update on the definition and diagnosis of Cheyne-Stokes breathing 1.

From the Research

Pathological Types of Breathing

• Cheyne-Stokes respiration (CSR) is a form of central sleep-disordered breathing characterized by cyclical fluctuations in breathing, leading to periods of central apneas/hypopnea, which alternate with periods of hyperpnea 2, 3.
• CSR is associated with severe congestive heart failure and is a compensation for the changing levels of blood oxygen and carbon dioxide 2.
• The pathogenesis of CSR involves a complex interplay of factors, including sleep disruption, arousals, hypoxemia-reoxygenation, hypercapnia/hypocapnia, and changes in intrathoracic pressure 2, 4.

Characteristics of Cheyne-Stokes Respiration

• CSR is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure 3.
• The crescendo-decrescendo pattern of respiration in CSR is a result of the changing levels of blood oxygen and carbon dioxide 2.
• CSR can also occur in healthy individuals with sleep, and was demonstrated in 1908 with voluntary hyperventilation, followed by apnea that Haldane blamed on hypoxia, subsequently called post-hyperventilation apnea 5.

Consequences of Cheyne-Stokes Respiration

• CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges 3.
• CSR impairs the quality of life and increases cardiac mortality in patients with heart failure 3, 4.
• CSR is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart 4.

Management of Cheyne-Stokes Respiration

• The management of CSR involves optimal control of underlying heart failure, oxygen therapy, and positive airway pressure support 2.
• Noninvasive adaptive servoventilation is currently the most promising treatment for CSR when it persists despite optimal therapy of heart failure 3.