Biot's Breathing

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Sleep

Abstract

Introduction: In 1875, Camille Biot observed an irregular breathing pattern—now called Biot’s breathing—in a patient with tuberculous meningitis. This pattern is characterized by rapid, shallow breaths followed by periods of apnea or gasping. Unlike Cheyne-Stokes respiration, which involves crescendo-decrescendo pattern of breathing influenced by vasomotor changes (increased heart rate and decreased blood pressure during the apneic phase), Biot’s breathing lacks such rhythmic fluctuations. Biot’s breathing is typically associated with damage to the brainstem, particularly the medulla oblongata or pons, from conditions such as trauma, stroke, infection, opioid abuse, or tentorial herniation. Disruption of the pneumotaxic center and respiratory control mechanisms in the brainstem may lead to intermittent hypoventilation and cyclic hypoxemia. This pattern is seen in critically ill patients who require intubation or are on mechanical ventilation. Report of case: A 76-year-old female was evaluated in the sleep clinic for snoring, witnessed apneas, gasping arousals, insomnia, and daytime fatigue. A home sleep apnea test diagnosed severe obstructive sleep apnea(OSA) with a Respiratory Event Index(REI) of 68.5. She was initially treated with autoCPAP(- continuous positive airway pressure) which showed elevated Apnea-hypopnea Index(AHI) prompting a need for a bilevel positive airway pressure(BiPAP) titration study. During the study, she was noted to have Biot’s breathing pattern. Titration was started at 8/4cmH2O to final pressure of 25/20cmH2O. Significant findings of this study were as follows: reduced sleep efficiency of 67.13%, fragmented sleep and an elevated AHI despite titration. Further investigation revealed that two months prior, patient had a fall and likely traumatic brain injury. CT scan of the brain showed minimal periventricular hypoattenuation but no acute trauma. Patient also had hydrocodone on her medication list. She was eventually titrated to ASV which showed some improvement in her sleep apnea management. Conclusion: Biot’s breathing is a rare and underreported phenomenon with limited representation in literature. Although it is typically associated with conditions like meningitis, this case may represent a transient condition caused by inadequate ventilation during titration. While the patient had a recent fall and was using opioids, no traumatic injury or opioid overuse was confirmed. Further research is indicated to explore the relationship between Biot’s breathing and complex sleep-disordered breathing.

Volume

48

Issue

Suppl 1

First Page

A635

Last Page

A635

Comments

39th Annual Meeting of the Associated Professional Sleep Societies, June 8-11, 2025, Seattle, WA

DOI

10.1093/sleep/zsaf090.1483

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