Electrocardiographic Derived Cheyne-Stokes Respiration and Periodic Breathing in
Cheyne-Stokes respiration (CSR) and periodic breathing (PB) are associated with an increased risk for mortality and may provide an early sign of risk for deterioration. The purpose of this study was to determine whether electrocardiographic (ECG) derived CSR and PB differ among 100 healthy individuals, 90 patients presenting to the emergency department with acute coronary syndrome symptoms and 172 critically-ill patients admitted to the intensive care unit (ICU); and whether CSR and PB provide an early sign of risk for adverse outcome in 24 critically ill patients in the ICU. Adverse events were defined as cardiac arrest, emergency endotracheal intubation, prolonged mechanical ventilation post-surgery, and all cause in-hospital mortality that occurred during admission; and, all-cause 30 day mortality that occurred after patient discharge.
CSR and PB data were measured using SuperECG software (Mortara Instrument, Milwaukee, WI), a computerized ECG measurement algorithm that measures CSR and PB by detecting beat to beat changes in QRS morphology.
When comparing the hospitalized group presenting to the emergency department with acute coronary symptoms to the healthy group, the hospitalized patients had 7.3 (CI=2.00-28.96) times more CSR episodes and 1.6 (CI=1.15-2.38) times more PB episodes than healthy participants.
Furthermore, when comparing the critically ill group admitted to the ICU to the healthy participant group, the critically ill patients had 1.71 times more CSR (CI=.95-3.52) and 1.35 times more PB (CI=1.07-1.69) than healthy participants.
Lastly, patients who suffered an adverse event in the ICU had 2 times more CSR (CI= .58 - 5.47) and .73 times more PB (CI= .47 – 1.07) than patients who did not suffer an adverse event; however, these increased abnormal breathing patterns were not statistically significant. Cox regression showed that risk for adverse event increases by 4% per every CSR episode increase (CI = .99-1.08, p=.07).
In conclusion, CSR and PB differ between a healthy population and hospitalized or critically ill patients. More research needs to be done to assess the clinical value of CSR and PB in detecting risk for adverse events.