Chemical control of respiratory frequency and tidal volume during sleep in preterm infants

Rigatto, Henrique; Kalapesi, Zarin; Leahy, Fergus; Durand, Manuel; MacCallum, Marilyn; Cates, Don

doi:10.1016/0034-5687(80)90027-4

Cited by 23 publications

(12 citation statements)

References 14 publications

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“…The increase in fre quency was related to a significant shortening of Ti, although Te also tended to decrease. Similar findings were obtained by Rigatto et al [4] in preterm infants and Phillipson et al [5] in adult dogs. On the other hand, Haddad et al [6] found an increase in VT and frequen cy when breathing changed from quiet to REM sleep, and this may have been related to the fact that they studied full-term infants at a somewhat later postnatal age.…”

Section: Fig 2 Diagrammatic Changes In Vt 'Timing' Andsupporting

confidence: 81%

“…Similarly, it is not clear whether the changes in ventilation from quiet to REM sleep are primarily related to changes in tidal volume (Vt) or in frequency. Some investigators have found no change in VT and an increase in frequency [4,5], some have found an increase in Vt and frequency [6], and some have shown no change in Vt and a decrease in frequency when sleep state changes from quiet to REM sleep [7], To clarify some of these discrepancies and char acterize the electrical activity of the dia phragm during quiet and REM sleep, we measured surface and esophageal electrical activity of the diaphragm in preterm infants during sleep. We hypothesized that the elec tromyography of these two regions of the diaphragm (EMGdi) would differ in these sleep states, as the esophageal electrodes would not be affected by adjacent muscles and are invariably affected when recording is from the surface electrodes.…”

Section: Introductionmentioning

confidence: 99%

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Diaphragmatic Activity and Ventilation in Preterm Infants

Reis

Cates²,

Landriault³

et al. 1994

Neonatology

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To determine the effects of sleep on diaphragmatic activity and ventilation we studied 10 preterm infants (birth weight 1,840 ± 50 g, gestational age 33 ± 0.6 weeks, and postnatal age 9.4 ± 1.4 days). We measured surface and esophageal diaphragmatic electromyograms (EMG_di). Ventilation was measured using a nasal flowmeter and a flow-through system. Diaphragmatic activity was analyzed for total phasic activity, expiratory phasic activity, the expiratory to total phasic activity ratio, and the presence of ‘tonic’activity. The latter was defined by the presence of electrical activity and the end of expiration. There was a decrease in the average total phasic activity (1.25 vs. 0.71 s, p = 0.001), expiratory phasic activity (0.67 vs. 0.21 s, p = 0.002), the expiratory to total phasic activity ratio (0.51:0.27 s, p = 0.001) and tonic activity (51 to 5%, p = 0.01) from quiet to REM sleep in the surface EMG_di. Similar changes were found in the esophageal EMG_di, except that tonic activity was rarely observed. In parallel with these changes in electrical activity of the diaphragm, minute ventilation and alveolar ventilation increased from quiet to REM sleep. This increase was primarily related to an increase in frequency with a negligible change in tidal volume. The increase in frequency was primarily due to shortening of inspiratory time. The findings that tonic activity recorded via surface electrodes decreased substantially from quiet to REM sleep and was not observed in the esophageal EMG_di suggests that this tonic activity may represent electrical activity of the postural muscles of the chest wall rather than the diaphragm.

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Section: Fig 2 Diagrammatic Changes In Vt 'Timing' Andsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Diaphragmatic Activity and Ventilation in Preterm Infants

Reis

Cates²,

Landriault³

et al. 1994

Neonatology

Self Cite

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“…This method depends heavily on EEG, EOG and EMG criteria. Using these criteria, for example, periodic breathing can be identified during periods of NREM sleep (12). Inasmuch as body movements and breathing patterns may effect V02, this may have contributed the differences in the observed data.…”

Section: 3)mentioning

confidence: 99%

The Effect of Sleep State on Active Thermoregulation in the Premature Infant

Darnall

Ariagno

1982

Pediatr Res

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Summaryduring extended periods might heavily contribute to the overall Alterations in thermoregulatory mechanisms related to sleep state may play an important role in the problems of homeostasis experienced by the premature infant. In the adult, homeothermic regulation of body temperature may. be suspended during REM. We measured oxygen consumption (VOz) in six premature infants 33-35 wk gestation both at thermoneutrality and during a mild thermal stress to determine whether thermoregulatory responses were intact during REM sleep. All infants were studied under radiant warmers. Skin temperature was allowed to fall 7-8 times during a 6-8 h study period while VOz, VCOZ, heart rate and TcPOz were continuously recorded. Sleep state was scored using EEG, EOG, EMG and behavioral criteria. A total of 1,162 onemin epochs were scored. In all states including REM, VOZ was significantly higher during the cool periods. The mean increases: 21.5%, 23.3%, 11.1% and 5.3% for Awake, Indeterminate, REM and NREM respectively. When REM and NREM were compared at thermoneutrality, there was no difference in the VOZ (8.80 + 0.11 and 8.93 f 0.15 cc/kg/min, mean f S.E., for REM and NREM, respectively). We conclude that in contrast to the adult, active thermoregulation occurs in the premature infant during REM sleep. SpeculationIn the adult, the reason for temporary poikilothermy during REM sleep is unknown. Some have considered this phesomenon a regression to a phylogenetically primitive condition which is necessarv for normal hvpothalamic function. Because the newborn " -period is characterized by profound ontogenic change, it is reasonable to s~eculate that the difference we observed between the premature and the adult is due to a developmental phenomenon. We further suggest that this developmental process may serve to protect the premature infant during REM sleep from extended periods of poikilothermy.Alterations in thermoregulatorv mechanisms related to sleep state may play an importaGt role the problems of homeostask ex~erienced bv the Dremature infant. Verv little information is av'ailable conckrning'the effects of arousal itate on the control of body temperature. As early as 1941, Day (4) observed a fall in rectal temperature with the onset of sleep in children. The decline in rectal temperature was coincident with increased evaporative water loss and rise in skin temperature indicating that the observed changes were possibly regulated phenomenon.In the adult, homeothermic regulation of body temperature may be suspended during REM sleep (9). Normal responses to cooling, such as shivering and vasomotor activity, seem to be absent during REM. Likewise, panting, sweating and vasomotor responses to warming also seem to be nonfunctional during REM (1 1). In contrast to the adult and older child, the newborn spends more time in REM sleep. A suspension of body temperature regulation poor control of body temperature in these infants.There has been little reported concerning the ability of the newborn to actively thermoregulate during sle...

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“…The mechanisms of the impact of warm stimuli on apneic episodes have not been elucidated. Several hypothesis have be put forward: changes in autonomic control 8,42 or bulbopontine mechanisms, 43 hypocapnia due to thermally induced hyperventilation, 44,45 and the impact of more effective inhibitory inputs on breathing patterns. 46,47 BHL is the sum of conductive, convective, radiant, and evaporative heat losses.…”

Section: Thermal Metabolic and Hypnic Parametersmentioning

confidence: 99%

Influence of Thermal Drive on Central Sleep Apnea in the Preterm Neonate

Tourneux

Cardot

Museux

et al. 2008

Sleep

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549 IN NEONATES, THE INCIDENCE OF APNEA DEPENDS ON A VARIETY OF FACTORS, SUCH AS BIRTH WEIGHT, 1 SEX, 2 GESTATIONAL AGE, 3 AND POSTNATAL AGE. 3,4 Central apnea is generally reported as occurring more frequently during active sleep than during quiet sleep. 2,3,[5][6][7] Many authors have pointed out that apnea incidence is also closely related to ambient temperature in both full-term [8][9][10] and preterm neonates 9,11,12 and that the rate of apneic events is increased by warm exposure (i.e., thermal drive). Although preterm neonates are more often exposed to cool stress than to warm stress, little is known about the influence of cool exposure on the incidence of apnea in the different sleep states. Bader et al 11 reported a lower rate of central apnea during transient decreases in incubator temperature from warm (29°C) to thermoneutral conditions (24°C) over 30 minutes, although this was only seen during quiet sleep for preterm infants and during active sleep for term infants.The mechanism linking thermal stress and apnea is unknown and thus warrants further investigation. On the basis of the above-cited studies, it can be supposed that suprapontine influences modify respiratory control, which must be considered as a multiple-interaction system. Abnormal functional interaction among the respiratory system, thermoregulatory system, and sleep processes may alter compensatory responses to autonomic cardiovascular or respiratory challenge and increase the likelihood of life-threatening events later in life. 13 The effect of thermal stress is usually assessed by monitoring the body's internal temperature (generally esophageal or rectal temperatures, which supposedly represent the core temperature) and/or mean skin temperature. 14 However, the central controller of the thermoregulatory system receives thermal inputs from thermosensitive structures distributed throughout the body. The regulated variable therefore results from a weighted sum of different body temperatures. 15 Hence, to fully understand the thermal influence on apnea incidence in cool environments, it is essential to quantify the magnitude of body cooling that is proportional to the radiant, convective, conductive, and evaporative heat losses (i.e., body heat loss) on the other. Any failure to maintain thermal balance stimulates the body's thermal control mechanisms and thus triggers regulatory adjustments. This approach may help clarify a hypothesis raised by Perlstein et al, 9 whereby apnea is not specifically induced by changes in air temperature but, rather, through processes controlling the overall body heat loss (BHL). Hence, in the present study, the role of thermal drive in the mechanisms underlying the genesis of central apnea in the sleeping neonate was assessed by taking into account BHL during mild warm and cool thermal exposures.Central apneic events were monitored in a group of 22 nearterm neonates. Indeed, there are few published studies on these infants, who are generally considered to be physiologically similar to term infants, even t...

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Chemical control of respiratory frequency and tidal volume during sleep in preterm infants

Cited by 23 publications

References 14 publications

Diaphragmatic Activity and Ventilation in Preterm Infants

Diaphragmatic Activity and Ventilation in Preterm Infants

The Effect of Sleep State on Active Thermoregulation in the Premature Infant

Influence of Thermal Drive on Central Sleep Apnea in the Preterm Neonate

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