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Elimination of central sleep apnoea by mitral valvuloplasty: the role of feedback delay in periodic breathing

¹ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
² Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
³ Division of Pulmonary - Critical Care Medicine, DVA Medical Center, Northpoint, NY and SUNY at Stony Brook School of Medicine, USA

Correspondence to:
Correspondence to:
Dr P L Smith
Room 4B67, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA; plsmith{at}jhmi.edu

ABSTRACT
Central sleep apnoea is a form of periodic breathing which resembles Cheyne-Stokes respiration but occurs only during sleep. One mechanism in the pathogenesis is a delay in chemical feedback from the lungs to the medullary respiratory centre. We explored the relationship between circulatory feedback delay in a patient with central sleep apnoea and Cheyne-Stokes respiration before and after mitral valve repair. Preoperatively the patient had severe central sleep apnoea and an increased circulation time. Following mitral valvuloplasty the circulation time was decreased with resolution of central sleep apnoea. This case demonstrates the role of feedback delay in central sleep apnoea and suggests that similar haemodynamic mechanisms may lead to central sleep apnoea and Cheyne-Stokes respiration.

Keywords: sleep apnoea; valvuloplasty

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