Gender differences in airway resistance during sleep

Trinder, John, Amanda Kay, Jan Kleiman, and Judith Dunai.Gender differences in airway resistance during sleep.J. Appl. Physiol. 83(6):1986-1997, 1997.At the onset of non-rapid-eye-movement (NREM)sleep there is a fall in ventilation and an increase in upper airwayresistance (UAR). In healthy men there is a progressive increase in UARas NREM sleep deepens. This study compared the pattern of change in UARand ventilation in 14 men and 14 women (aged 18-25 yr) both duringsleep onset and over the NREM phase of a sleep cycle (from wakefulnessto slow-wave sleep). During sleep onset, fluctuations betweenelectroencephalographic alpha and theta activity were associated withmean alterations in inspiratory minute ventilation and UAR of between 1 and 4.5 l/min and between 0.70 and 5.0 cmH₂O · l¹ · s,respectively, with no significant effect of gender on either change(P > 0.05). During NREM sleep,however, the increment in UAR was larger in men than in women(P < 0.01), such that the meanlevels of UAR at peak flow reached during slow-wave sleep were ~25and 10 cmH₂O · l¹ · sin men and women, respectively. We speculate that the greater increasein UAR in healthy young men may represent a gender-related susceptibility to sleep-disordered breathing that, in conjunction withother predisposing factors, may contribute to the development ofobstructive sleep apnea.

     

Arousal and ventilatory responses during sleep in children with obstructive sleep apnea

Abnormal centralregulation of upper airway muscles may contribute to thepathophysiology of the childhood obstructive sleep apnea syndrome(OSAS). We hypothesized that this was secondary to global abnormalitiesof ventilatory control during sleep. We therefore compared the responseto chemical stimuli during sleep between prepubertal children with OSASand controls. Patients with OSAS aroused at a higherPCO₂ (58 ± 2 vs. 60 ± 5 Torr,P < 0.05); those with the highestapnea index had the highest arousal threshold(r = 0.52, P < 0.05). The hypercapnic arousal threshold decreased after treatment. For all subjects, hypoxia was apoor stimulus to arousal, whereas hypercapnia and, particularly, hypoxic hypercapnia were potent stimuli to arousal. Hypercapnia resulted in decreased airway obstruction in OSAS. Ventilatory responseswere similar between patients with OSAS and controls; however, thesample size was small. We conclude that children with OSAS haveslightly blunted arousal responses to hypercapnia. However, the overallventilatory and arousal responses are normal in children with OSAS,indicating that a global deficit in respiratory drive is not a majorfactor in the etiology of childhood OSAS. Nevertheless, subtleabnormalities in ventilatory control may exist.

     

Control of breathing during sleep assessed by proportional assist ventilation

Meza, S., E. Giannouli, and M. Younes. Control ofbreathing during sleep assessed by proportional assist ventilation. J. Appl. Physiol. 84(1): 3-12, 1998.We used proportional assist ventilation (PAV) to evaluate thesources of respiratory drive during sleep. PAV increases the slope ofthe relation between tidal volume(VT) andrespiratory muscle pressure output (Pmus). We reasoned that ifrespiratory drive is dominated by chemical factors, progressiveincrease of PAV gain should result in only a small increase inVT because Pmus would bedownregulated substantially as a result of small decreases inPCO₂. In the presence of substantialnonchemical sources of drive [believed to be the case inrapid-eye-movement (REM) sleep] PAV should result in a substantial increase in minute ventilation and reductionin PCO₂ as the output related to thechemically insensitive drive source is amplified severalfold. Twelvenormal subjects underwent polysomnography while connected to a PAVventilator. Continuous positive air pressure (5.2 ± 2.0 cmH₂O) was administered tostabilize the upper airway. PAV was increased in 2-min steps from 0 to20, 40, 60, 80, and 90% of the subject's elastance and resistance.VT, respiratory rate, minuteventilation, and end-tidal CO₂pressure were measured at the different levels, and Pmus wascalculated. Observations were obtained in stage 2 sleep (n = 12), slow-wave sleep(n = 11), and REM sleep(n = 7). In all cases, Pmus wassubstantially downregulated with increase in assist so that theincrease in VT, althoughsignificant (P < 0.05), was small(0.08 liter at the highest assist). There was no difference in responsebetween REM and non-REM sleep. We conclude that respiratory driveduring sleep is dominated by chemical control and that there is nofundamental difference between REM and non-REM sleep in this regard.REM sleep appears to simply add bidirectional noise to what isbasically a chemically controlled respiratory output.

     

Skeletal muscle chemoreflex and pHi in exercise ventilatory control

Oelberg, David A., Allison B. Evans, Mirko I. Hrovat, PaulP. Pappagianopoulos, Samuel Patz, and David M. Systrom. Skeletal muscle chemoreflex and pH_i inexercise ventilatory control. J. Appl.Physiol. 84(2): 676-682, 1998.To determinewhether skeletal muscle hydrogen ion mediates ventilatory drive inhumans during exercise, 12 healthy subjects performed three bouts ofisotonic submaximal quadriceps exercise on each of 2 days in a 1.5-Tmagnet for ³¹P-magnetic resonancespectroscopy(³¹P-MRS). Bilaterallower extremity positive pressure cuffs were inflated to 45 Torr duringexercise (BLPP_ex) or recovery(BLPP_rec) in a randomized orderto accentuate a muscle chemoreflex. Simultaneous measurements were madeof breath-by-breath expired gases and minute ventilation, arterializedvenous blood, and by ³¹P-MRS ofthe vastus medialis, acquired from the average of 12 radio-frequencypulses at a repetition time of 2.5 s. WithBLPP_ex, end-exercise minuteventilation was higher (53.3 ± 3.8 vs. 37.3 ± 2.2 l/min;P < 0.0001), arterializedPCO₂ lower (33 ± 1 vs. 36 ± 1 Torr; P = 0.0009), and quadricepsintracellular pH (pH_i) more acid (6.44 ± 0.07 vs. 6.62 ± 0.07; P = 0.004), compared withBLPP_rec. Bloodlactate was modestly increased withBLPP_ex but without a change inarterialized pH. For each subject, pH_i was linearly relatedto minute ventilation during exercise but not to arterialized pH. Thesedata suggest that skeletal muscle hydrogen ion contributes to theexercise ventilatory response.

     

Effect of prior O2 breathing on ventilatory response to sustained isocapnic hypoxia in adult humans

Honda, Y., H. Tani, A. Masuda, T. Kobayashi, T. Nishino, H. Kimura, S. Masuyama, and T. Kuriyama. Effect of priorO₂ breathing on ventilatoryresponse to sustained isocapnic hypoxia in adult humans.J. Appl. Physiol. 81(4):1627-1632, 1996.Sixteen healthy volunteers breathed 100%O₂ or room air for 10 min in random order, then their ventilatory response to sustained normocapnic hypoxia (80% arterial O₂saturation, as measured with a pulse oximeter) was studied for 20 min.In addition, to detect agents possibly responsible for the respiratorychanges, blood plasma of 10 of the 16 subjects was chemically analyzed.1) Preliminary O₂ breathing uniformly andsubstantially augmented hypoxic ventilatory responses.2) However, the profile ofventilatory response in terms of relative magnitude, i.e., biphasichypoxic ventilatory depression, remained nearly unchanged.3) Augmented ventilatory incrementby prior O₂ breathing wassignificantly correlated with increment in the plasma glutamine level.We conclude that preliminary O₂administration enhances hypoxic ventilatory response without affectingthe biphasic response pattern and speculate that the excitatory aminoacid neurotransmitter glutamate, possibly derived from augmentedglutamine, may, at least in part, play a role in this ventilatoryenhancement.

     

Role of endogenous female hormones in hypoxic chemosensitivity

Tatsumi, Koichiro, Cheryl K. Pickett, Christopher R. Jacoby,John V. Weil, and Lorna G. Moore. Role of endogenous female hormones in hypoxic chemosensitivity. J. Appl.Physiol. 83(5): 1706-1710, 1997.Effective alveolar ventilation and hypoxicventilatory response (HVR) are higher in females than in males andafter endogenous or exogenous elevation of progesterone and estrogen.The contribution of normal physiological levels of ovarian hormones toresting ventilation and ventilatory control and whether their site(s) of action is central and/or peripheral are unclear.Accordingly, we examined resting ventilation, HVR, and hypercapnicventilatory responses (HCVR) before and 3 wk after ovariectomy in fivefemale cats. We also compared carotid sinus nerve (CSN) and centralnervous system translation responses to hypoxia in 6 ovariectomized and 24 intact female animals. Ovariectomy decreased serum progesterone butdid not change resting ventilation, end-tidalPCO₂, or HCVR (allP = NS). Ovariectomy reduced theHVR shape parameter A in the awake(38.9 ± 5.5 and 21.2 ± 3.0 before and after ovariectomy, respectively, P < 0.05) andanesthetized conditions. The CSN response to hypoxia was lower inovariectomized than in intact animals (shape parameterA = 22.6 ± 2.5 and 54.3 ± 3.5 in ovariectomized and intact animals, respectively,P < 0.05), but central nervous system translation of CSN activity into ventilation was similar inovariectomized and intact animals. We concluded that ovariectomy decreased ventilatory and CSN responsiveness to hypoxia, suggesting that the presence of physiological levels of ovarian hormones influences hypoxic chemosensitivity by acting primarily at peripheral sites.

     

Effect of different levels of hyperoxia on breathing in healthy subjects

Becker, Heinrich F., Olli Polo, Stephen G. McNamara, MichaelBerthon-Jones, and Colin E. Sullivan. Effect of different levelsof hyperoxia on breathing in healthy subjects. J. Appl. Physiol. 81(4): 1683-1690, 1996.Wehave recently shown that breathing 50%O₂ markedly stimulates ventilationin healthy subjects if end-tidal PCO₂(PET_CO2) ismaintained. The aim of this study was to investigate apossible dose-dependent stimulation of ventilation byO₂ and to examine possiblemechanisms of hyperoxic hyperventilation. In eight normalsubjects ventilation was measured while they were breathing 30 and 75%O₂ for 30 min, withPET_CO2 being held constant.Acute hypercapnic ventilatory responses were also tested in thesesubjects. The 75% O₂ experimentwas repeated without controllingPET_CO2 in 14 subjects, andin 6 subjects arterial blood gases were taken at baseline and at theend of the hyperoxia period. Minute ventilation(I) increased by 21 and 115% with 30 and 75% isocapnic hyperoxia, respectively. The 75%O₂ without any control onPET_CO2 led toa 16% increase inI, butPET_CO2 decreased by3.6 Torr (9%). There was a linear correlation(r = 0.83) between the hypercapnic and the hyperoxic ventilatory response. In conclusion, isocapnic hyperoxia stimulates ventilation in a dose-dependent way, withI more than doubling after 30 min of75% O₂. If isocapnia is notmaintained, hyperventilation is attenuated by a decrease in arterialPCO₂. There is a correlation betweenhyperoxic and hypercapnic ventilatory responses. On the basis of datafrom the literature, we concluded that the Haldane effect seems to bethe major cause of hyperventilation duringboth isocapnic and poikilocapnichyperoxia.

     

Interaction of chemical and state effects on ventilation during sleep onset

Dunai, Judith, Mal Wilkinson, and John Trinder.Interaction of chemical and state effects on ventilation duringsleep onset. J. Appl. Physiol. 81(5):2235-2243, 1996.Ventilation varies as a function of state, beinghigher during wakefulness (as indicated by alpha electroencephalogramactivity) than during sleep (theta activity). A recent experimentobserved a progressive increase in the magnitude of these state-relatedfluctuations in ventilation over the sleep-onset period (28). The aimof the present experiment was to test the hypothesis that this effectresulted from chemical (feedback-related) amplification of stateeffects on ventilation. A hyperoxic condition was used to eliminateperipheral chemoreceptor activity. It was hypothesized that hyperoxiawould reduce the amplification of changes in ventilation associatedwith electroencephalogram state transitions. Ventilation was measuredover the sleep-onset period under both hyperoxic and normoxicconditions in 10 young healthy male subjects. Sleep onsets were dividedinto three phases. Phase 1 corresponded to presleep wakefulness; andphases 2 and 3 corresponded to early and late sleep onset,respectively. The magnitudes of state-related changes in ventilationduring phases 2 and 3, and under hyperoxic and normoxic conditions werecompared using a phase by condition analysis of variance. Resultsrevealed a significant phase by condition interaction, confirming that hyperoxia reduced the amplification of state-related changes in ventilation by selectively decreasing the magnitude of phase 3 statechanges in ventilation. However, some degree of amplification wasevident during hyperoxia, thus the results demonstrated that peripheralchemoreceptor activity contributed to the amplification ofstate-related changes in ventilation but that additional factors mayalso be involved.

     

When does the lung die? Kfc, cell viability, and adenine nucleotide changes in the circulation-arrested rat lung

Jones, David R., Randy M. Becker, Steve C. Hoffmann, John J. Lemasters, and Thomas M. Egan. When does the lungdie? K_fc, cellviability, and adenine nucleotide changes in the circulation-arrested rat lung. J. Appl. Physiol. 83(1):247-252, 1997.Lungs harvested from cadavericcirculation-arrested donors may increase the donor pool for lungtransplantation. To determine the degree and time course ofischemia-reperfusion injury, we evaluated the effect ofO₂ ventilation on capillarypermeability [capillary filtration coefficient(K_fc)],cell viability, and total adenine nucleotide (TAN) levels in in situcirculation-arrested rat lungs.K_fc increased with increasing postmortem ischemic time(r = 0.88). Lungs ventilated withO₂ 1 h postmortem had similarK_fc andwet-to-dry ratios as controls. Nonventilated lungs had threefold(P < 0.05) and sevenfold (P < 0.0001) increases inK_fc at 30 and 60 min postmortem compared with controls. Cell viability decreased inall groups except for 30-min postmortemO₂-ventilated lungs. TAN levelsdecreased with increasing ischemic time, particularly in nonventilatedlungs. Loss of adenine nucleotides correlated with increasingK_fc values (r = 0.76). This study indicates thatlungs retrieved 1 h postmortem may have normalK_fc withpreharvest O₂ ventilation. Therelationship betweenK_fc and TANsuggests that vascular permeability may be related to lung TAN levels.

     

Ventilatory response to exercise in subjects breathing CO2 or HeO2

Babb, T. G. Ventilatory response to exercise insubjects breathing CO₂ orHeO₂.J. Appl. Physiol. 82(3): 746-754, 1997.To investigate the effects of mechanical ventilatory limitationon the ventilatory response to exercise, eight older subjects with normal lung function were studied. Each subject performed graded cycleergometry to exhaustion once while breathing room air; once whilebreathing 3% CO₂-21%O₂-balanceN₂; and once while breathing HeO₂ (79% He and 21%O₂). Minute ventilation(E) and respiratory mechanics weremeasured continuously during each 1-min increment in work rate (10 or20 W). Data were analyzed at rest, at ventilatory threshold (VTh),and at maximal exercise. When the subjects were breathing 3%CO₂, there was an increase(P < 0.001) inE at rest and at VTh but not duringmaximal exercise. When the subjects were breathingHeO₂,E was increased(P < 0.05) only during maximalexercise (24 ± 11%). The ventilatory response to exercise belowVTh was greater only when the subjects were breathing 3% CO₂(P < 0.05). Above VTh, theventilatory response when the subjects were breathingHeO₂ was greater than whenbreathing 3% CO₂(P < 0.01). Flow limitation, aspercent of tidal volume, during maximal exercise was greater(P < 0.01) when the subjects werebreathing CO₂ (22 ± 12%) thanwhen breathing room air (12 ± 9%) or when breathingHeO₂ (10 ± 7%)(n = 7). End-expiratory lung volumeduring maximal exercise was lower when the subjects were breathingHeO₂ than when breathing room airor when breathing CO₂(P < 0.01). These data indicate thatolder subjects have little reserve for accommodating an increase inventilatory demand and suggest that mechanical ventilatory constraintsinfluence both the magnitude of Eduring maximal exercise and the regulation ofE and respiratory mechanics duringheavy-to-maximal exercise.

     

Development of ventilatory responsiveness to progressive hypoxia and hypercapnia in low-birth-weight lambs

Moss, T. J., M. G. Davey, G. J. McCrabb, and R. Harding.Development of ventilatory responsiveness to progressive hypoxia and hypercapnia in low-birth-weight lambs. J. Appl.Physiol. 81(4): 1555-1561, 1996.Our aim was todetermine the effects of low birth weight on ventilatory responses toprogressive hypoxia and hypercapnia during early postnatal life. Sevenlow-birth-weight (2.7 ± 0.3 kg) and five normal-birth-weight (4.8 ± 0.2 kg) lambs, all born at term, underwent weekly rebreathingtests during wakefulness while arterialPO₂,PCO₂, and pH were measured. Hypoxicventilatory responsiveness (HOVR; percent increase in ventilation whenarterial PO₂ fell to 60% of resting values) increased in normal lambs from 86.6 ± 7.1% atweek 1 to 227.4 ± 24.9% atweek 6. In low-birth-weight lambs,HOVR was not significantly different at week1 (60.1 ± 18.7%) from that of normal lambs but didnot increase with postnatal age (56.6 ± 19.3% atweek 6). HOVR of all lambs at 6 wkwas significantly correlated with birth weight(r² = 0.8).Hypercapnic ventilatory responsiveness (gradient of ventilation vs.arterial PCO₂) did not change withage and was not significantly different between groups [84.7 ± 7.5 (low-birth-weight lambs) vs. 89.4 ± 6.6 ml ^· min^{1 ·} kg^{1 ·} mmHg¹(normal lambs)]. We conclude that intrauterine conditions that impair fetal growth lead to the failure of HOVR to increase with age.

     

Abdominal muscle fatigue after maximal ventilation in humans

Kyroussis, Dimitris, Gary H. Mills, Michael I. Polkey,Carl-Hugo Hamnegard, Nicholaos Koulouris, Malcolm Green, and John Moxham. Abdominal muscle fatigue after maximal ventilation inhumans. J. Appl. Physiol. 81(4):1477-1483, 1996.Abdominal muscles are the principal muscles ofactive expiration. To investigate the possibility of abdominal musclelow-frequency fatigue after maximal ventilation in humans, westimulated the nerve roots supplying the abdominal muscles. We used amagnetic stimulator (Magstim 200) powering a 90-mm circular coil andstudied six normal subjects. To assess the optimum level of stimulationand posture, we stimulated at each intervertebral level betweenT₇ andL₁ in the prone, supine, andseated positions. At T₁₀, we usedincreasing power outputs to assess the pressure-power relationship.Care was taken to avoid muscle potentiation. Twitch gastric pressure(Pga) was recorded with a balloon-tipped catheter. Mean (±SD)baseline twitch Pga measured with the subjects in the prone position atT₁₀ was 23.5 ± 5.4 cmH₂O. Within-occasion mean twitchPga coefficient of variation was 4.6 ± 1.1%. Twitch Pga wasmeasured with the subjects in the prone position with stimulation overT₁₀ before and after 2 min ofmaximal isocapnic ventilation (MIV). Twenty minutes after MIV, meantwitch Pga fell by 17 ± 9.1%(P = 0.03) and remained low 90 minafter MIV. We conclude that after maximal ventilation in humans thereis a reduction of twitch Pga and, therefore, of low-frequency fatiguein abdominal muscles.

     

Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea

Xie, Ailiang, Fiona Rankin, Ruth Rutherford, and T. DouglasBradley. Effects of inhaledCO₂ and added dead space on idiopathic central sleep apnea. J. Appl.Physiol. 82(3): 918-926, 1997.We hypothesizedthat reductions in arterial PCO₂ (Pa_CO2) below the apnea threshold play akey role in the pathogenesis of idiopathic central sleep apnea syndrome(ICSAS). If so, we reasoned that raisingPa_CO2 would abolish apneas in thesepatients. Accordingly, patients with ICSAS were studied overnight onfour occasions during which the fraction of end-tidalCO₂ and transcutaneous PCO₂ were measured: during room airbreathing (N1), alternating room airand CO₂ breathing(N2),CO₂ breathing all night(N3), and addition of dead space viaa face mask all night (N4).Central apneas were invariably preceded by reductions infraction of end-tidal CO₂. Bothadministration of a CO₂-enrichedgas mixture and addition of dead space induced 1- to 3-Torr increasesin transcutaneous PCO₂, whichvirtually eliminated apneas and hypopneas; they decreased from43.7 ± 7.3 apneas and hypopneas/h onN1 to 5.8 ± 0.9 apneas andhypopneas/h during N3(P < 0.005), from 43.8 ± 6.9 apneas and hypopneas/h during room air breathing to 5.9 ± 2.5 apneas and hypopneas/h of sleep duringCO₂ inhalation during N2 (P < 0.01), and to 11.6% of the room air level while the patients werebreathing through added dead space duringN4 (P < 0.005). Because raisingPa_CO2 through two different meansvirtually eliminated central sleep apneas, we conclude that centralapneas during sleep in ICSA are due to reductions inPa_CO2 below the apnea threshold.

     

Within-night variation in respiratory effort preceding apnea termination and EEG delta power in sleep apnea

We studied the within-night variability of themaximum esophageal pressure deflection before apnea termination(DP_max) in nine patients withsevere obstructive sleep apnea as an index of the arousal threshold andthe mean electroencephalogram (EEG) delta power for each 30 s as anindex of the timing of sleep cycles. Periodicity in the time variationof delta power and DP_max was analyzed by determining their power spectral density and their relationship determined by cross correlation.DP_max and delta power variedcyclically and in phase with a major periodicity (major peak in powerspectral density) of 117.6 ± 8.8 (SE) min. The correlation betweenthe values of DP_max and deltapower was significant (P < 0.001) ineach subject (mean r = 0.47 ± 0.03), and the coherence betweenDP_max and delta power at theirdominant frequency was high. Within cycles of non-rapid-eye-movementsleep, DP_max and delta powerincreased, reaching peak values on average at or after midcycle. Thesefindings suggest that the arousal threshold to airway occlusion inpatients with obstructive sleep apnea varies cyclically during thenight synchronous to the underlying cycles of sleep.

     

Ventilation distribution during histamine provocation

Verbanck, S., D. Schuermans, A. Van Muylem, M. Paiva, M. Noppen, and W. Vincken. Ventilation distribution during histamine provocation. J. Appl. Physiol. 83(6):1907-1916, 1997.We investigated ventilation inhomogeneity duringprovocation with inhaled histamine in 20 asymptomatic nonsmokingsubjects. We used N₂multiple-breath washout (MBW) to deriveparameters S_condand S_acin as ameasurement of ventilation inhomogeneity in conductive and acinar zonesof the lungs, respectively. A 20% decrease of forced expiratory volume in 1 s (FEV₁) was used todistinguish responders from nonresponders. In the responder group,average FEV₁ decreased by 26%,whereas S_condincreased by 390% with no significant change inS_acin. In thenonresponder group, FEV₁ decreasedby 11%, whereasS_cond increased by 198% with no significantS_acin change.Despite the absence of change inS_acin duringprovocation, baselineS_acin wassignificantly larger in the responder vs. the nonresponder group. Themain findings of our study are that during provocation largeventilation inhomogeneities occur, that the small airways affected bythe provocation process are situated proximal to the acinar zone wherethe diffusion front stands, and that, in addition to overall decreasein airway caliber, there is inhomogeneous narrowing of parallelairways.

     

Ventilatory effects of specific carotid body hypocapnia and hypoxia in awake dogs

Smith, Curtis A., Craig A. Harms, Kathleen S. Henderson, andJerome A. Dempsey. Ventilatory effects of specific carotid bodyhypocapnia and hypoxia in awake dogs. J. Appl.Physiol. 82(3): 791-798, 1997.Specific carotidbody (CB) hypocapnia in the 10-Torr (less than eupneic) rangereduced ventilation in the awake and sleeping dog to the same degree asdid CB hyperoxia [CB PO₂ (PCB_O2);>500 Torr; C. A. Smith, K. W. Saupe, K. S. Henderson, and J. A. Dempsey. J. Appl. Physiol. 79:689-699, 1995], suggesting a powerful inhibitory effect ofhypocapnia at the carotid chemosensor over a range ofPCO₂ encountered commonly inphysiological hyperpneas. The primary purpose of this study was toassess the ventilatory effect of CB hypocapnia on the ventilatoryresponse to concomitant CB hypoxia. The secondary purpose was to assess the relative gains of the CB and central chemoreceptors to hypocapnia. In eight awake female dogs the vascularly isolated CB was perfused withhypoxic blood (mild,PCB_O2 50 Torr or severe, PCB_O2 36 Torr) in a background of normocapnia or hypocapnia (10 Torr lessthan eupneic arterial PCO₂) in theperfusate. The systemic (and brain) circulation was normoxicthroughout, and arterial PCO₂ was notcontrolled (poikilocapnia). With CB hypocapnia, the peak ventilation(range 19-27 s) in response to hypoxic CB perfusion increased 48%(mild) and 77% (severe) due to increased tidal volume. When CBhypocapnia was present, these increases in ventilation were reduced to21 and 27%, respectively. With systemic hypocapnia, with the isolatedCB maintained normocapnic and hypoxic for >70 s, the steady-statepoikilocapnic ventilatory response (i.e., to systemic hypocapnia alone)decreased 15% (mild CB hypoxia) and 27% (severe CB hypoxia) from thepeak response, respectively. We conclude that carotid body hypocapniacan be a major source of inhibitory feedback to respiratory motoroutput during the hyperventilatory response to hypoxic carotid bodystimulation.

     

Sequential arousal and airway-defensive behavior of infants in asphyxial sleep environments

Lijowska, Anna S., Nevada W. Reed, Barbara A. MertinsChiodini, and Bradley T. Thach. Sequential arousaland airway-defensive behavior of infants in asphyxial sleepenvironments. J. Appl. Physiol. 83(1):219-228, 1997.Infants are prone to accidental asphyxiation.Therefore, we studied airway-defensive behaviors and their relationshipto spontaneous arousal behavior in 41 healthy sleeping infants(2-26 wk old), using two protocols:1) infant was rebreathing expiredair, face covered by bedding material; and2) infant was exposed tohypercarbia, face uncovered. Multiple measurements of respiratory andmotor activities were recorded (video, polygraph). The infants'response to increasing hypercarbia consisted of four highly stereotypedbehaviors: sighs (augmented breaths), startles, thrashing limbmovements, and full arousal (eyes open, cry). These behaviors occurredabruptly in self-limited clusters of activity and always in the samesequence: first a sigh coupled with a startle, then thrashing, thenfull arousal. Incomplete sequences (initial behaviors only) occurredfar more frequently than the complete sequence and were variablyeffective in removing the bedding covering the airway. In bothprotocols, as inspired CO₂increased, incomplete arousal sequences recurred periodically and withincreasing frequency and complexity until the infant either succeededin clearing his/her airway or was completely aroused. Spontaneousarousal sequences, identical to those occurring during hypercarbia,occurred periodically during sleep. This observation suggests that theinfant's airway-defensive responses to hypercarbia consist of anincrease in the frequency and complexity of an endogenously regulated,periodically occurring sequence of arousal behaviors.

     

Effects of haloperidol on ventilation during isocapnic hypoxia in humans

Pedersen, Michala E. F., Keith L. Dorrington, and Peter A. Robbins. Effects of haloperidol on ventilation during isocapnic hypoxia in humans. J. Appl. Physiol.83(4): 1110-1115, 1997.Exposure to isocapnic hypoxia produces anabrupt increase in ventilation [acute hypoxic ventilatoryresponse (AHVR)], which is followed by a subsequent decline[hypoxic ventilatory depression or decline (HVD)]. In cats, both anesthetized and awake,haloperidol has been reported to increase AHVR and almost entirelyabolish HVD. To investigate whether this occurs in humans, theventilatory responses of 15 healthy young volunteers to 20 min ofisocapnic hypoxia (end-tidal PO₂ = 50 Torr) were assessed at 1, 2, and 4.5 h after placebo (control) andafter oral haloperidol (Seranace, 0.05 mg/kg) on different days. Threesubjects were unable to complete the study because of akathisia. AHVRwas significantly greater with haloperidol compared with control(P < 0.01, analysis of variance).However, no significant change in HVD was found [control HVD = 9.3 ± 1.6 (SD) l/min, haloperidol HVD = 9.9 ± 2.1 l/min;P = not significant, analysis ofvariance]. We conclude that combined central and peripheraldopamine-receptor antagonism in humans with haloperidol produces asimilar pattern of change to that reported previously with theperipheral antagonist domperidone. We have been unable to show inhumans a decrease in HVD by the centrally acting drug as observed incats.

     

Effects of carotid body hypocapnia during ventilatory acclimatization to hypoxia

Dwinell, M. R., P. L. Janssen, J. Pizarro, and G. E. Bisgard. Effects of carotid body hypocapnia during ventilatory acclimatization to hypoxia. J. Appl.Physiol. 82(1): 118-124, 1997.Hypoxicventilatory sensitivity is increased during ventilatory acclimatizationto hypoxia (VAH) in awake goats, resulting in a time-dependent increasein expired ventilation (E). Theobjectives of this study were to determine whether the increasedcarotid body (CB) hypoxic sensitivity is dependent on the level of CB CO₂ and whether the CBCO₂ gain is changed during VAH.Studies were carried out in adult goats with CB blood gases controlled by an extracorporeal circuit while systemic (central nervous system) blood gases were regulated independently by the level of inhaled gases. Acute E responsesto CB hypoxia (CB PO₂ 40 Torr) and CBhypercapnia (CB PCO₂ 50 and 60 Torr)were measured while systemic normoxia and isocapnia were maintained. CBPO₂ was then lowered to 40 Torr for 4 h while the systemic blood gases were kept normoxic and normocapnic.During the 4-h CB hypoxia, E increasedin a time-dependent manner. Thirty minutes after return to normoxia,the ventilatory response to CB hypoxia was significantly increasedcompared with the initial response. The slope of the CBCO₂ response was also elevatedafter VAH. An additional group of goats(n = 7) was studied with asimilar protocol, except that CB PCO₂was lowered throughout the 4-h hypoxic exposure to prevent reflexhyperventilation. CB PCO₂ wasprogressively lowered throughout the 4-h CB hypoxic period to maintainE at the control level. After the 4-hCB hypoxic exposure, the ventilatory response to hypoxia was alsosignificantly elevated. However, the slope of the CBCO₂ response was not elevatedafter the 4-h hypoxic exposure. These results suggest that CBsensitivity to both O₂ andCO₂ is increased after 4 h of CBhypoxia with systemic isocapnia. The increase in CB hypoxic sensitivityis not dependent on the level of CBCO₂ maintained during the 4-hhypoxic period.

     

Tidal volume effects on surfactant treatment responses with the initiation of ventilation in preterm lambs

Wada, Kazuko, Alan H. Jobe, and Machiko Ikegami. Tidalvolume effects on surfactant treatment responses with the initiation ofventilation in preterm lambs. J. Appl.Physiol. 83(4): 1054-1061, 1997.We hypothesizedthat initiation of ventilation in preterm lambs with high volumes wouldcause lung injury and decrease the subsequent response to surfactanttreatment. Preterm lambs were randomized to ventilation for 30 minafter birth with 5 ml/kg (VT5),10 ml/kg (VT10), or 20 ml/kg(VT20) tidal volumes and then ventilated with ~10 ml/kg tidal volumes to achieve arterialPCO₂ values of ~50 Torr to 6 h ofage. VT20 lambs had lowercompliances, lower ventilatory efficiencies, higher recoveries ofprotein, and lower recoveries of surfactant in alveolar lavages and in surfactant that had decreased compliances when tested in preterm rabbits than VT5 orVT10 lambs. Other lambsrandomized to treatment with surfactant at birth and ventilation with6, 12, or 20 ml/kg tidal volumes for 30 min had no indicators of lunginjury. An initial tidal volume of 20 ml/kg decreased the subsequentresponse to surfactant treatment, an effect that was prevented withsurfactant treatment at birth.