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Theophylline Therapy for Cheyne-Stokes Respiration During Sleep in a 41-Year-Old Man With Refractory Arterial HypertensionBP and Theophylline for Cheyne-Stokes Respiration

Jacek Wolf, MD, PhD; Ewa Świerblewska, MD, PhD; Hanna Jasiel-Wojculewicz, MD, PhD; Krzysztof Gockowski, MD, PhD; Bogdan Wyrzykowski, MD, PhD; Virend K. Somers, MD, PhD, FCCP; Krzysztof Narkiewicz, MD, PhD
Author and Funding Information

From the Department of Hypertension and Diabetology (Drs Wolf, Świerblewska, Jasiel-Wojculewicz, Gockowski, Wyrzykowski, and Narkiewicz) Medical University of Gdańsk, Gdańsk, Poland; the Division of Cardiovascular Diseases (Dr Somers), Mayo Clinic, Rochester MN; and the Department of Cardiovascular Diseases (Drs Wolf and Narkiewicz), International Clinical Research Center, St. Anne’s University Hospital in Brno (FNUSA), Brno, Czech Republic.

Correspondence to: Jacek Wolf, MD, PhD, Medical University of Gdańsk, Department of Hypertension and Diabetology, Dębinki 7C, 80-952 Gdańsk, Poland; e-mail: lupus@gumed.edu.pl


Funding/Support: Dr Somers is supported by the National Institutes of Health [Grant NIH R01 HL65176]. Drs Wolf and Narkiewicz are supported by the European Regional Development Fund, Project FNUSA-ICRC [Grant CZ.1.05/1.1.00/02.0123] and by the REGPOT ICRC-ERA Human Bridge [Grant 316345] provided by the European Union.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):e8-e10. doi:10.1378/chest.13-2897
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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.

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