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Virend K. Somers - One of the best experts on this subject based on the ideXlab platform.

  • Bioprofiles and mechanistic pathways associated with Cheyne-Stokes Respiration: insights from the SERVE-HF trial
    Clinical Research in Cardiology, 2019
    Co-Authors: João Pedro Ferreira, Kévin Duarte, Holger Woehrle, Martin R. Cowie, Christiane Angermann, Marie-pia D’ortho, Erland Erdmann, Patrick Levy, Anita K. Simonds, Virend K. Somers
    Abstract:

    Introduction The SERVE-HF trial included patients with heart failure and reduced ejection fraction (HFrEF) with sleep-disordered breathing, randomly assigned to treatment with Adaptive-Servo Ventilation ( ASV) or control. The primary outcome was the first event of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening heart failure. A subgroup analysis of the SERVE-HF trial suggested that patients with Cheyne-Stokes Respiration (CSR)  90% were male. Patients with CSR 

  • Theophylline Therapy for Near-Fatal Cheyne–Stokes Respiration
    2016
    Co-Authors: Catherine A. Pesek, Do Ryan Cooley, Neal L. Weintraub, Virend K. Somers, Ann Intern Med
    Abstract:

    Background: Cheyne–Stokes Respiration is characterized by periodic breathing that alternates with hypopnea or apnea. Objective: To describe the effect of theophylline on near-fatal Cheyne–Stokes Respiration. Design: Case report. Setting: Tertiary referral center. Patient: A 48-year-old diabetic woman with a history of three cardiorespiratory arrests, a normal coronary arterio-gram, normal left ventricular function, and severe Cheyne– Stokes Respiration. Measurements: Oxygen saturation, intra-arterial blood pressure, central venous pressure, chest wall movement, electrocardiography, electromyography, electroencepha-lography, electro-oculography, minute ventilation, arte-rial blood gases, and serum theophylline levels. Results: After intravenous administration of 1.2 mg of theophylline at 0.6 mg/kg per hour (serum level, 5.6 mg/ mL), both Cheyne–Stokes Respiration and oxygen desatu-ration were markedly attenuated. After infusion of 2.4 mg of theophylline (serum level, 11.6 mg/mL), Cheyne–Stokes Respiration resolved completely. No change was seen with placebo. Cheyne–Stokes Respiration did not recur during outpatient treatment with oral theophylline. Conclusion: Theophylline may be a rapid and effective therapy for life-threatening Cheyne–Stokes Respiration. This paper is also available a

  • Theophylline Therapy for Cheyne-Stokes Respiration During Sleep in a 41-Year-Old Man With Refractory Arterial Hypertension
    Chest, 2014
    Co-Authors: Jacek Wolf, Virend K. Somers, Ewa Świerblewska, Hanna Jasiel-wojculewicz, Krzysztof Gockowski, Bogdan Wyrzykowski, Krzysztof Narkiewicz
    Abstract:

    We report a case of a 41-year-old man who was noted to have position-dependent Cheyne-Stokes Respiration with central sleep apnea (CSA) during sleep. The patient had multiple cardiovascular risk factors and target organ damages, including a history of two myocardial infarctions, transient ischemic attack, and chronic kidney disease. His hypertension was refractory to a number of antihypertensive medicines, however, a complete elimination of sleep-disordered breathing with oral theophylline treatment was paralleled by a significant BP fall with a subsequent need for reduction of antihypertensive drugs. Following these surprising observations we decided to withdraw theophylline from treatment (in-clinic). Theophylline discontinuation resulted in a gradual increase in BP and an urgent call for antihypertensive treatment modification. These observations suggest a potent hypotensive action of oral theophylline via Cheyne-Stokes Respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime.

  • Theophylline Therapy for Near-Fatal Cheyne–Stokes Respiration: A Case Report
    Annals of internal medicine, 1999
    Co-Authors: Catherine A. Pesek, Neal L. Weintraub, Ryan L. Cooley, Krzysztof Narkiewicz, Mark Eric Dyken, Virend K. Somers
    Abstract:

    Theophylline may be a rapid and effective therapy for life-threatening Cheyne–Stokes Respiration.

Matthew T. Naughton - One of the best experts on this subject based on the ideXlab platform.

  • cheyne stokes Respiration friend or foe
    Thorax, 2012
    Co-Authors: Matthew T. Naughton
    Abstract:

    Background Orthopnoea and paroxysmal nocturnal dyspnoea are common entities regularly confronting thoracic physicians, particularly those with an interest in sleep medicine or non-invasive ventilatory support. One major cause is heart failure (HF), usually associated with abnormal lung function tests, and either obstructive or central sleep apnoea with Cheyne–Stokes Respiration (CSA–CSR). Whereas obstructive apnoea is considered injurious to the cardiovascular system, the effects of CSA–CSR are less clear and may be a compensatory response to severe HF. Aim To determine whether there are compensatory or possibly beneficial aspects caused by CSA–CSR in HF. Methods Literature review. Results CSA–CSR can be detrimental in terms of intermittent hypoxaemia, arousals and autonomic dysregulation. However, it is also associated with the beneficial effects of hyperventilation-related increases in end-expiratory lung volume, intrinsic positive airway pressure, assistance to stroke volume, attenuation of excessive sympathetic nervous activity, avoidance of hypercapnic acidosis and finally the provision of periodic rest to fatigue-prone respiratory pump muscles. Conclusions CSA–CSR has physiological features more likely to be compensatory and beneficial than injurious in HF. Some aspects of CSA–CSR are similar to those seen with positive airway pressure.

  • Cheyne–Stokes Respiration: friend or foe?
    Thorax, 2012
    Co-Authors: Matthew T. Naughton
    Abstract:

    Background Orthopnoea and paroxysmal nocturnal dyspnoea are common entities regularly confronting thoracic physicians, particularly those with an interest in sleep medicine or non-invasive ventilatory support. One major cause is heart failure (HF), usually associated with abnormal lung function tests, and either obstructive or central sleep apnoea with Cheyne–Stokes Respiration (CSA–CSR). Whereas obstructive apnoea is considered injurious to the cardiovascular system, the effects of CSA–CSR are less clear and may be a compensatory response to severe HF. Aim To determine whether there are compensatory or possibly beneficial aspects caused by CSA–CSR in HF. Methods Literature review. Results CSA–CSR can be detrimental in terms of intermittent hypoxaemia, arousals and autonomic dysregulation. However, it is also associated with the beneficial effects of hyperventilation-related increases in end-expiratory lung volume, intrinsic positive airway pressure, assistance to stroke volume, attenuation of excessive sympathetic nervous activity, avoidance of hypercapnic acidosis and finally the provision of periodic rest to fatigue-prone respiratory pump muscles. Conclusions CSA–CSR has physiological features more likely to be compensatory and beneficial than injurious in HF. Some aspects of CSA–CSR are similar to those seen with positive airway pressure.

  • Pathophysiology and treatment of Cheyne-Stokes Respiration
    Thorax, 1998
    Co-Authors: Matthew T. Naughton
    Abstract:

    Cheyne-Stokes Respiration is a disorder characterised by recurrent central apnoeas during sleep alternating with a crescendo-decrescendo pattern of tidal volume.1 2 It is often observed in patients with congestive heart failure, usually during stages 1 and 2 non-REM sleep when ventilation is under chemical-metabolic control.2 Patients with Cheyne-Stokes Respiration usually present with the symptoms of orthopnoea, paroxysmal nocturnal dyspnoea, excessive daytime sleepiness and witnessed apnoeas in the setting of congestive heart failure.1 3 Excessive weight and snoring may be absent. Approximately 50% of patients with symptomatic congestive heart failure have sleep apnoea, mainly of the Cheyne-Stokes Respiration variety.4-6 As congestive heart failure occurs in 1% of the adult population and doubles in prevalence for each decade beyond 60 years,7 Cheyne-Stokes Respiration is common but often left unrecognised. Based upon small case series, patients with congestive heart failure and Cheyne-Stokes Respiration have a significantly greater mortality,8 9 particularly if present during wakefulness,10 than those without Cheyne-Stokes Respiration. Although Cheyne-Stokes Respiration is likely to arise as a result of congestive heart failure, once present it is likely to have adverse effects upon cardiac function akin to a vicious cycle. Following an initial cardiac insult there is a compensatory increase in sympathetic activity11 12 which in susceptible patients causes hyperventilation,13 destabilises respiratory control, and leads to Cheyne-Stokes Respiration. Once Cheyne-Stokes Respiration is established, apnoea related hypoxaemia causes cardiac diastolic dysfunction.14 Hypoxaemia and arousals lead to further increases in sympathetic activity15 which contribute to potentially fatal arrhythmias16-18 and further cardiotoxicity.19 Hyperventilation and resultant increased work of the respiratory muscles probably play a part in the symptom of paroxysmal nocturnal dyspnoea1 and place an increased demand upon the already reduced cardiac output.20 Finally, patients with congestive heart failure and Cheyne-Stokes …

  • Pathophysiology and treatment of Cheyne-Stokes Respiration
    Thorax, 1998
    Co-Authors: Matthew T. Naughton
    Abstract:

    Cheyne-Stokes Respiration is a disorder characterised by recurrent central apnoeas during sleep alternating with a crescendo-decrescendo pattern of tidal volume.1 2 It is often observed in patients with congestive heart failure, usually during stages 1 and 2 non-REM sleep when ventilation is under chemical-metabolic control.2 Patients with Cheyne-Stokes Respiration usually present with the symptoms of orthopnoea, paroxysmal nocturnal dyspnoea, excessive daytime sleepiness and witnessed apnoeas in the setting of congestive heart failure.1 3 Excessive weight and snoring may be absent. Approximately 50% of patients with symptomatic congestive heart failure have sleep apnoea, mainly of the Cheyne-Stokes Respiration variety.4-6 As congestive heart failure occurs in 1% of the adult population and doubles in prevalence for each decade beyond 60 years,7 Cheyne-Stokes Respiration is common but often left unrecognised. Based upon small case series, patients with congestive heart failure and Cheyne-Stokes Respiration have a significantly greater mortality,8 9 particularly if present during wakefulness,10 than those without Cheyne-Stokes Respiration. Although Cheyne-Stokes Respiration is likely to arise as a result of congestive heart failure, once present it is likely to have adverse effects upon cardiac function akin to a vicious cycle. Following an initial cardiac insult there is a compensatory increase in sympathetic activity11 12 which in susceptible patients causes hyperventilation,13 destabilises respiratory control, and leads to Cheyne-Stokes Respiration. Once Cheyne-Stokes Respiration is established, apnoea related hypoxaemia causes cardiac diastolic dysfunction.14 Hypoxaemia and arousals lead to further increases in sympathetic activity15 which contribute to potentially fatal arrhythmias16-18 and further cardiotoxicity.19 Hyperventilation and resultant increased work of the respiratory muscles probably play a part in the symptom of paroxysmal nocturnal dyspnoea1 and place an increased demand upon the already reduced cardiac output.20 Finally, patients with congestive heart failure and Cheyne-Stokes …

Olaf Oldenburg - One of the best experts on this subject based on the ideXlab platform.

  • Hemodynamic effects of Cheyne-Stokes Respiration in heart failure?
    European Respiratory Journal, 2014
    Co-Authors: Olaf Oldenburg, Henrik Fox, Jens Spießhöfer, Thomas Bitter, Dieter Horstkotte
    Abstract:

    Cheyne-Stokes Respiration (CSR) in heart failure (HF) patients is characterized by hyperventilation (HV) with low arterial partial pressure of CO 2 (pCO 2 ). It is still questioned whether this HL characterizes a compensatory response to HF or represents an independent comorbidity. Aim of the present study was to investigate the hemodynamic effects of HL. Hemodynamic effects of voluntary HV were investigated in 15 healthy volunteers (HVOL; 13 male, 25±4 years, BNP 55%) and 19 HF patients (14male, 67±12years, NYHA class 2.6±0.6, BNP 802±839pg/ml, LV-EF 33.5 ±9.0%). Non-invasive hemodynamic monitoring was used in HVOL whereas invasive measurements were used in HF patients. Transcutaneous (tc) pCO 2 was used in HVOL and aortal blood gas analysis was used in HF patients to verify and quantify HV. During HV PtcCO 2 in HVOL dropped from 38.74±2.5 to 28.6±3.3 mmHg (p 2 in HF patients from 33.0 ± 3.6 to 22.3 ± 3.3mmHg (p HV leads to an increase in cardiac output in healthy volunteers as well as in heart failure patients. This increase is mainly due to an increase in heart rate. Cheyne-Stokes Respiration with associated hyperventilation might be a compensatory mechanism in patients with a failing heart, but because this is due to an increase in heart rate, it might be deleterious in the long run.

  • Implications of revised AASM rules on scoring apneic and hypopneic respiratory events in patients with heart failure with nocturnal Cheyne-Stokes Respiration.
    Sleep & breathing = Schlaf & Atmung, 2014
    Co-Authors: Jessica Heinrich, Thomas Bitter, Jens Spießhöfer, Dieter Horstkotte, Olaf Oldenburg
    Abstract:

    Study objectives This study investigated the implications of the revised scoring rules of the American Academy of Sleep Medicine (AASM) in patients with heart failure (HF) with Cheyne-Stokes Respiration (CSR).

  • Acute improvement of pulmonary hemodynamics does not alleviate Cheyne-Stokes Respiration in chronic heart failure – a randomized, controlled, double-blind, crossover trial
    Pneumologie, 2014
    Co-Authors: Thomas Bitter, Dieter Horstkotte, H Schmalgemeier, Andrea Zwenke, M Möllenberg, J Dohrmann, Olaf Oldenburg
    Abstract:

    Objectives This randomized, controlled trial aimed to investigate whether acute improvement of pulmonary congestion would reduce the severity of Cheyne-Stokes Respiration (CSR) in patients with chronic heart failure (CHF).

  • Treatment of Cheyne-Stokes Respiration Reduces Arrhythmic Events in Chronic Heart Failure
    Journal of cardiovascular electrophysiology, 2013
    Co-Authors: Thomas Bitter, Dieter Horstkotte, Klaus-jürgen Gutleben, Georg Nölker, Nina Westerheide, Christian Prinz, Zisis Dimitriadis, Jürgen Vogt, Olaf Oldenburg
    Abstract:

    Cheyne-Stokes Respiration and Arrhythmias ObjectiveThis study aimed to investigate whether adequate treatment of Cheyne-Stokes Respiration (CSR) reduces the risk of arrhythmic events in patients with chronic heart failure (CHF). MethodsA cohort of 403 registry patients with CHF (LVEF45%, NYHA-class2) and implanted cardioverter-defibrillator devices (ICD) was studied. They underwent overnight polygraphy, with 221 having mild or no CSR (apnea-hypopnea index [AHI] 15/h). Latter ones were offered therapy with adaptive servoventilation (ASV), which 96 patients accepted and 86 rejected. During follow-up (21 15 months) defibrillator therapies were recorded in addition to clinical and physiologic measures of heart failure severity. ResultsEvent-free survival from (a) appropriate cardioverter-defibrillator therapies and (b) appropriately monitored ventricular arrhythmias was shorter in the untreated CSR group compared to the treated CSR and the no CSR group. Stepwise Cox proportional hazard regression analysis showed untreated CSR (a: hazard ratio [HR] 1.99, 95% confidence interval [CI] 1.46-2.72, P < 0.001; b: HR 2.19, 95%CI 1.42-3.37, P < 0.001), but not treated CSR (a: HR 1.06, 95%CI 0.74-1.50; P = 0.77; b: HR 1.21, 95%CI 0.75-1.93, P = 0.43) was an independent risk factor. The treated CSR group showed improvements in cardiac function and respiratory stability compared to the untreated CSR group. ConclusionThis study demonstrates a decrease of appropriate defibrillator therapies by ASV treated CSR in patients with CHF and ICD. A reduced exposure to hyperventilation, hypoxia, and improvement in indices of CHF severity and neurohumoral disarrangements are potential causative mechanisms.

  • CIRCADIAN VARIATION OF ICD-SHOCKS IN PATIENTS WITH CHRONIC HEART FAILURE: THE IMPACT OF Cheyne-Stokes Respiration AND OBSTRUCTIVE SLEEP APNEA
    Journal of the American College of Cardiology, 2013
    Co-Authors: Thomas Bitter, Dieter Horstkotte, Christian Prinz, Zisis Dimitriadis, Andrea Zwenke, Natalie Prib, Olaf Oldenburg
    Abstract:

    Previous studies confirmed Cheyne-Stokes Respiration (CSA) and obstructive sleep apnea (OSA) to be independently associated with adequate implanted cardioverter-defibrillator (ICD) therapies in patients with chronic heart failure (CHF) to prevent sudden cardiac death. This study aims to clarify the

Thomas Brack - One of the best experts on this subject based on the ideXlab platform.

  • Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments
    Respiration; international review of thoracic diseases, 2011
    Co-Authors: Thomas Brack, Winfried Randerath, Konrad E. Bloch
    Abstract:

    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. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment.

  • Cheyne-Stokes Respiration in patients with heart failure: ominous sign or innocent bystander?
    Swiss medical weekly, 2007
    Co-Authors: Thomas Brack
    Abstract:

    Cheyne-Stokes Respiration (CSR) during the day and at night is common in patients with severe heart failure. CSR harms the failing heart through recurrent sympathetic overstimulation caused by sleep disturbances and intermittent hypoxia brought about by apnoea and hypopnoea. CSR impairs patients' quality of life and wakefulness, and probably also increases cardiac mortality in patients with heart failure. Thus, CSR should be actively sought in patients with a left ventricular ejection fraction

  • Fluctuations in End-Expiratory Lung Volume during Cheyne-Stokes Respiration
    American journal of respiratory and critical care medicine, 2005
    Co-Authors: Thomas Brack, Amal Jubran, Franco Laghi, Martin J. Tobin
    Abstract:

    We hypothesized that patients with Cheyne-Stokes Respiration exhibit periodic increases in end-expiratory lung volume, mediated by changes in breath components, postinspiratory inspiratory muscle activity, or both. Calibrated inductive plethysmography revealed that 12 of 12 patients with Cheyne-Stokes Respiration experienced increases in end-expiratory volume during hyperpnea: maximum 412 ± 112 (SE) ml (range 75–1,543 ml). Compared with quiet breathing, the breath with largest increase in end-expiratory volume had larger tidal volume (867 ± 107 vs. 567 ± 38 ml, p < 0.01) and shorter expiratory time (1.25 ± 0.11 vs. 1.66 ± 0.15 seconds, p < 0.05). During decrescendo, the breath with largest decrease in end-expiratory volume had smaller tidal volume (p < 0.01) and longer expiratory time (p < 0.01). Cross-correlation of time series revealed that end-expiratory volume was related to both breath components (p < 0.0001). Bipolar needle electrodes revealed that scalene muscle activity at end-expiration was 50.7 ...

  • Cardiac resynchronization therapy, central sleep apnea, and Cheyne-Stokes Respiration in chronic heart failure patients.
    Journal of the American College of Cardiology, 2005
    Co-Authors: Christoph Scharf, Thomas Brack, Alexander Turk, Konrad E. Bloch
    Abstract:

    We congratulate Sinha et al. ([1][1]) for their interesting and innovative report in JACC on the therapeutic effect of biventricular pacing on central sleep apnea (CSA). A few questions remain: the title suggests some information about Cheyne-Stokes Respiration (CSR), which is not equivalent to CSA

  • Cheyne-Stokes Respiration in patients with congestive heart failure.
    Swiss medical weekly, 2003
    Co-Authors: Thomas Brack
    Abstract:

    Cheyne-Stokes Respiration (CSR) is a breathing pattern characterised by rhythmic oscillation of tidal volume with regularly recurring periods of hyperpnoea, hypopnoea and apnoea. CSR is no longer solely regarded as a symptom of severe congestive heart failure (CHF), but has been recognised as an independent risk factor for worsening heart failure and reduced survival in patients with CHF. CSR is associated with frequent awakening that fragment sleep and with concomitant sympathetic activation both of which may worsen CHF. Cheyne-Stokes Respiration is very common in patients with severe CHF and its prevalence may have been underestimated in the past due to technical limitations that precluded respiratory monitoring outside sleep laboratories. Since treatment of CSR appears to be beneficial and safe, patients at risk should be promptly diagnosed and treated. Treatment of CSR has been demonstrated to improve left ventricular ejection fraction and potentially prolongs survival in patients with severe CHF. This article briefly summarises the current knowledge of the patho-physiology, prevalence and therapy of Cheyne-Stokes Respiration.

Alberto Giannoni - One of the best experts on this subject based on the ideXlab platform.

  • Reply: Upright Cheyne-Stokes Respiration in Heart Failure: An Ominous Sign of Cardiovascular Dysregulation.
    Journal of the American College of Cardiology, 2020
    Co-Authors: Alberto Giannoni, Michele Emdin, Francesco Gentile, Paolo Sciarrone, Claudio Passino
    Abstract:

    We thank Drs. Fudim and Soloveva for their speculations on the relevance of pre-load and baroreflex as pathophysiological determinants of the persistence of Cheyne-Stokes Respiration (CSR) in the upright position, described in our large series of patients with chronic systolic heart failure (n =

  • Ld-EEG Effective Brain Connectivity in Patients With Cheyne-Stokes Respiration
    IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society, 2020
    Co-Authors: Alejandro Luis Callara, Maria Sole Morelli, Valentina Hartwig, Luigi Landini, Alberto Giannoni, Claudio Passino, Michele Emdin, Nicola Vanello
    Abstract:

    The characterization of brain cortical activity in heart-failure patients affected by Cheyne-Stokes Respiration might provide relevant information about the mechanism underlying this pathology. Central autonomic network is gaining increasing attention for its role in the regulation of breathing and cardiac functions. In this scenario, evaluating changes in cortical connectivity associated with Cheyne-Stokes Respiration may be of interest in the study of specific brain-activity related to such disease. Nonetheless, the inter subject variability, the temporal dynamics of Central-Apnea/Hyperpnea cycles and the limitations of clinical setups lead to different methodological challenges. To this aim, we present a framework for the assessment of cortico-cortical interactions from Electroencephalographic signals acquired using low-density caps and block-design paradigms, arising from endogenous triggers. The framework combines ICA-decomposition, unsupervised clustering, MVAR modelling and a permutation-bootstrap strategy for evaluating significant connectivity differences between conditions. A common network, lateralized towards the left hemisphere, was depicted across 8 patients exhibiting Cheyne-Stokes Respiration patterns during acquisitions. Significant differences in connectivity at the group level were observed based on patients’ ventilatory condition. Interactions were significantly higher during hyperpnea periods with respect to central apneas and occurred mainly in the delta band. Opposite-sign differences were observed for higher frequencies (i.e. beta, low-gamma).

  • persistence of periodic breathing cheyne stokes Respiration after tilt table test during short term respiratory monitoring in patients with systolic heart failure
    Journal of the American College of Cardiology, 2018
    Co-Authors: Chiara Borrelli, Claudio Passino, Michele Emdin, Francesco Gentile, Paolo Sciarrone, Federico Rossari, Gianluca Mirizzi, Francesca Bramanti, Giovanni Iudice, Alberto Giannoni
    Abstract:

    Although periodic breathing (PB: hyperventilation/hypopneas) and Cheyne-Stokes Respiration (CSR: hyperventilation/apneas) are usually considered to occur in lying and sleeping conditions in patients with heart failure (HF), there are recent evidences that both phenomena may spread throughout the 24-

  • Reversal of Ticagrelor-Induced Arrhythmias and Cheyne-Stokes Respiration With Aminophylline Infusion.
    Journal of cardiovascular pharmacology, 2017
    Co-Authors: Lorenzo Conte, Nicola Riccardo Pugliese, Alberto Giannoni
    Abstract:

    Dyspnea and bradyarrhythmias are frequent adverse effects (AEs) of ticagrelor. AEs commonly occur within the first week of therapy, are dose related and usually mild, but sometimes they may cause drug discontinuation. Currently, the exact mechanisms of ticagrelor-related AEs have not been definitively explained. In addition to the prevalent theory of adenosine overload, other reasonable mechanism like a direct central stimulation hypothesis was suggested. We present a case of incessant Cheyne-Stokes Respiration associated with heart rate instability in patient with congestive heart failure and non-ST-segment elevation myocardial infarction, supporting the use of aminophylline as a potential reversal agent of ticagrelor-related AEs.