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The control of breathing results from a complex interaction involving the respiratory centers, which feed signals to a central control mechanism that, in turn, provides output to the effector muscles. In this review, we describe the individual elements of this system, and what is known about their function in man. We outline clinically relevant aspects of the integration of human ventilatory control system, and describe altered function in response to special circumstances, disorders, and medications. We emphasize the clinical relevance of this topic by employing case presentations of active patients from our practice.(CHEST 2000; 117:205-225)Key words: carotid body; chemoreceptors; control of ventilation; pulmonary receptors Abbreviations: CPAP ϭ continuous positive airway pressure; CSF ϭ cerebrospinal fluid; CSR ϭ Cheyne-Stokes respiration; DRG ϭ dorsal respiratory group; [H ϩ ] ϭ hydrogen ion concentration; HCO 3 Ϫ ϭ bicarbonate; MVV ϭ maximal voluntary ventilation; OSA ϭ obstructive sleep apnea; pHa ϭ arterial pH; PIIA ϭ postinspiration inspiratory activity; PImax ϭ maximal inspiratory pressure; RAR ϭ rapidly adapting receptor; REM ϭ rapid eye movement; Sao 2 ϭ arterial oxygen saturation; SAR ϭ slowly adapting receptor; VC ϭ vital capacity; V e ϭ minute ventilation; V o 2 ϭ oxygen uptake; V /Q ϭ ventilation/perfusion; VRG ϭ ventral respiratory group; Vt ϭ tidal volume; WOB ϭ work of breathing

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OSA patients who have core depressive symptoms (as measured by MMPI scale D) without significant psychological symptoms in other areas tend to have less severe OSA, whereas those with a diverse set of other psychological symptoms overshadowing depressive symptoms (e.g., somatic focus, emotional reactivity, family/marital problems, cognitive problems, etc.) tend to have greater AHI and lower oxygen saturation. Although it seems probable that these MMPI differences primarily reflect OSA effects, prospective research is needed to confirm this hypothesis.