We hypothesised that hypocretin (orexin) plays a role in the determination of ventilatory chemosensitivity. 130 patients with narcolepsy-cataplexy (mean¡SD age 20¡10 yrs, 69% male) and 117 controls (22¡6.9 yrs, 62% male) were recruited and tested for human leukocyte antigen (HLA)-DQB1*0602 status, hyperoxia hypercapnic (change in minute ventilation (DV9E)/carbon dioxide tension (DPCO 2 ) L?min KEYWORDS: Chemoresponsiveness, human leukocyte antigen DQB1, hypercapnia, hypoxia, narcolepsy H ypoxic and hypercapnic sensing are processed through neuromuscular circuits resulting in an increase or decrease of tidal volume, respiratory frequency and minute ventilation (V9E). Such chemosensory reflexes operate to influence sleep apnoea, chronic obstructive pulmonary disease (COPD), heart failure, and acute adaptation to high altitude [1]. A variation in chemosensitivity across various inbred rodent strains and familial clustering of ventilatory traits in humans provides a strong rationale for gene and protein isolation efforts to unravel molecular mechanisms for these traits operating in health and disease [2].Hypocretin (orexin) is a hypothalamic neurotransmitter, which, when given intracerebroventricularly in mice, promotes both wakefulness and ventilation [3,4]. Both hypocretin knockout and hypocretin neuron-ablated mice show attenuation of respiratory excitation during fightor-flight responses [5]. Particular to chemoresponsiveness, hypocretin/orexin knockout mice have attenuated hypercapnic ventilatory responses [6]; supplementation of hypocretin-1 or -2 partially restores an attenuated response to hypercapnia, while administration of hypocretin receptor-1 antagonist will reduce hypercapnic responsiveness in wild type mice [7]. Post-hypoxic long-term facilitation, a physiological feature that is presumed to reduce sleep apnoea, is absent in hypocretin/orexin knockout mice [8].The human model of hypocretin deficiency is narcolepsy with cataplexy [9,10]. This disorder is also associated with the gene marker, human leukocyte antigen (HLA)-DQB1*0602 [11]. This disease is also considered to be associated with a higher expression of sleep-disordered breathing [12,13]. Our primary hypothesis was that an impaired chemoresponsiveness would be present