Polysomnographic studies of nocturnal sleep were performed on a 63-year-old women. Sleep-onset and sleep-maintenance insomnia dated back to a cerebral infarction at age 53, which resulted in bilateral cerebral injury. Two patterns of respiration were observed, and both were sleep-stage-dependent. Classic Cheyne-Stokes respiration predominated during slow-wave sleep and stages 1 and 2. REM sleep, in contrast, was associated almost exclusively with normal respiration. Recurrent brief arousals, temporally linked to the Cheyne-Stokes pattern of respiration, markedly disturbed sleep stages 1 and 2 and appeared related to the patient's subjective sleep complaints. During waking, REM, and NREM sleep, respiration is known to have different sensitivity to CNS and peripheral controls. The selective association of Cheyne-Stokes respiration with NREM sleep in this patient supports the view that anatomically separate CNS mechanisms regulate respiration in REM and NREM sleep.
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