Effects of Breath-Hold Deep Diving on the Pulmonary System

Schipke, Jochen D.; Lemaître, F.; Cleveland, Sinclair; Tetzlaff, Kay

doi:10.1159/000495757

Cited by 16 publications

(12 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Yet, it is still not clear whether lung squeeze can be attributed to the compression and alveolar collapse during descent, the cumulative strain and capillary stress failure under compression, or the decompression and reopening during ascent. Irrespective of exactly where this threshold occurs, exceeding such a limit is a major contributor to the incidence of pulmonary barotrauma – notably, pulmonary oedema, haemoptysis and an impairment in pulmonary gas exchange (Boussuges et al., 1999; Lindholm et al., 2008; Mijacika & Dujic, 2016; Schipke et al., 2019). This was well demonstrated by Lindholm et al.…”

Section: Introductionmentioning

confidence: 99%

Temporal changes in pulmonary gas exchange efficiency when breath‐hold diving below residual volume

Patrician

Spajić

Gasho

et al. 2021

Experimental Physiology

View full text Add to dashboard Cite

Breath-hold diving involves highly integrative and extreme physiological responses to both exercise and asphyxia during progressive elevations in hydrostatic pressure. Over two diving training camps (Study 1 and 2), 25 breath-hold divers (recreational to worldchampion) performed 66 dives to 57 ± 20 m (range: 18-117 m). Using the deepest dive from each diver, temporal changes in cardiopulmonary function were assessed using non-invasive pulmonary gas exchange (indexed via the O 2 deficit), ultrasound B-line scores, lung compliance and pulmonary haemodynamics at baseline and following the dive. Hydrostatically induced lung compression was quantified in Study 2, using spirometry and lung volume measurement, enabling each dive to be categorized by its residual volume (RV)-equivalent depth. From both studies, pulmonary gas exchange inefficiency-defined as an increase in O 2 deficit-was related to the depth of the dive (r 2 = 0.345; P < 0.001), with dives associated with lung squeeze symptoms exhibiting the greatest deficits. In Study 1, although B-lines doubled from baseline (P = 0.027), cardiac output and pulmonary artery systolic pressure were unchanged post-dive. In Study 2, dives with lung compression to ≤RV had higher O 2 deficits at 9 min, compared to dives that did not exceed RV (24 ± 25 vs. 5 ± 8 mmHg; P = 0.021). The physiological significance of a small increase in estimated lung compliance post-dive (via decreased and increased/unaltered airway resistance and reactance, respectively) remains equivocal. Following deep dives, the current study highlights an integrated link between hydrostatically induced lung compression and transient impairments in pulmonary gas exchange efficiency.

show abstract

Section: Introductionmentioning

confidence: 99%

Temporal changes in pulmonary gas exchange efficiency when breath‐hold diving below residual volume

Patrician

Spajić

Gasho

et al. 2021

Experimental Physiology

View full text Add to dashboard Cite

show abstract

“…First, the increase in lung stretch through deep inspiration stimulates the lung stretch receptors in the bronchi (Sroufe, 1971), which in their turn inhibit the cardiac vagal nerves and increase heart rate. Second, the deep inspiration at high lung volume is suggested to increase intrathoracic pressure which limits venous return and stroke volume and causes a drop in blood pressure and an increase in heart rate (Andersson and Schagatay, 1997;Schipke et al, 2019). This drop in blood pressure has been observed before in trained breath-hold divers (Schagatay et al, 1999;Sivieri et al, 2015;Ratmanova et al, 2016).…”

Section: Discussionmentioning

confidence: 83%

Heart Rate and Muscle Oxygenation Kinetics During Dynamic Constant Load Intermittent Breath-Holds

et al. 2021

View full text Add to dashboard Cite

Introduction: Acute apnea evokes bradycardia and peripheral vasoconstriction in order to conserve oxygen, which is more pronounced with face immersion. This response is contrary to the tachycardia and increased blood flow to muscle tissue related to the higher oxygen consumption during exercise. The aim of this study was to investigate cardiovascular and metabolic responses of dynamic dry apnea (DRA) and face immersed apnea (FIA).Methods: Ten female volunteers (17.1 ± 0.6 years old) naive to breath-hold-related sports, performed a series of seven dynamic 30 s breath-holds while cycling at 25% of their peak power output. This was performed in two separate conditions in a randomized order: FIA (15°C) and DRA. Heart rate and muscle tissue oxygenation through near-infrared spectroscopy were continuously measured to determine oxygenated (m[O2Hb]) and deoxygenated hemoglobin concentration (m[HHb]) and tissue oxygenation index (mTOI). Capillary blood lactate was measured 1 min after the first, third, fifth, and seventh breath-hold.Results: Average duration of the seven breath-holds did not differ between conditions (25.3 s ± 1.4 s, p = 0.231). The apnea-induced bradycardia was stronger with FIA (from 134 ± 4 to 85 ± 3 bpm) than DRA (from 134 ± 4 to 100 ± 5 bpm, p < 0.001). mTOI decreased significantly from 69.9 ± 0.9% to 63.0 ± 1.3% (p < 0.001) which is reflected in a steady decrease in m[O2Hb] (p < 0.001) and concomitant increase in m[HHb] (p = 0.001). However, this was similar in both conditions (0.121 < p < 0.542). Lactate was lower after the first apnea with FIA compared to DRA (p = 0.038), while no differences were observed in the other breath-holds.Conclusion: Our data show strong decreases in heart rate and muscle tissue oxygenation during dynamic apneas. A stronger bradycardia was observed in FIA, while muscle oxygenation was not different, suggesting that FIA did not influence muscle oxygenation. An order of mechanisms was observed in which, after an initial tachycardia, heart rate starts to decrease after muscle tissue deoxygenation occurs, suggesting a role of peripheral vasoconstriction in the apnea-induced bradycardia. The apnea-induced increase in lactate was lower in FIA during the first apnea, probably caused by the stronger bradycardia.

show abstract

“…Aligning with Linér and colleagues, our data shows a negative correlation between depth and SpO 2 ( Linér and Andersson, 2008 ). While persistent post-dive hypoxemia may have multiple causes: (1) ventilation/perfusion mismatch due to atelectasis ( Fahlman et al, 2009 ; Schipke et al, 2019 ). (2) increased right-to-left shunt; via increased strain on the right ventricle ( Scherhag et al, 2005 ) and/or chronic pulmonary hypertension ( Vestin, 2015 ), so if right atrial pressure becomes higher than left atrial pressure right-to-left shunting can occur ( Layoun et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving

et al. 2021

View full text Add to dashboard Cite

Breath-hold diving (freediving) is an underwater sport that is associated with elevated hydrostatic pressure, which has a compressive effect on the lungs that can lead to the development of pulmonary edema. Pulmonary edema reduces oxygen uptake and thereby the recovery from the hypoxia developed during freediving, and increases the risk of hypoxic syncope. We aimed to examine the efficacy of SpO2, via pulse-oximetry, as a tool to detect pulmonary edema by comparing it to lung ultrasound B-line measurements after deep diving. SpO2 and B-lines were collected in 40 freedivers participating in an international deep freediving competition. SpO2 was measured within 17 ± 6 min and lung B-lines using ultrasound within 44 ± 15 min after surfacing. A specific symptoms questionnaire was used during SpO2 measurements. We found a negative correlation between B-line score and minimum SpO2 (rs = −0.491; p = 0.002) and mean SpO2 (rs = −0.335; p = 0.046). B-line scores were positively correlated with depth (rs = 0.408; p = 0.013), confirming that extra-vascular lung water is increased with deeper dives. Compared to dives that were asymptomatic, symptomatic dives had a 27% greater B-line score, and both a lower mean and minimum SpO2 (all p < 0.05). Indeed, a minimum SpO2 ≤ 95% after a deep dive has a positive predictive value of 29% and a negative predictive value of 100% regarding symptoms. We concluded that elevated B-line scores are associated with reduced SpO2 after dives, suggesting that SpO2 via pulse oximetry could be a useful screening tool to detect increased extra-vascular lung water. The practical application is not to diagnose pulmonary edema based on SpO2 – as pulse oximetry is inexact – rather, to utilize it as a tool to determine which divers require further evaluation before returning to deep freediving.

show abstract

Effects of Breath-Hold Deep Diving on the Pulmonary System

Cited by 16 publications

References 53 publications

Temporal changes in pulmonary gas exchange efficiency when breath‐hold diving below residual volume

Temporal changes in pulmonary gas exchange efficiency when breath‐hold diving below residual volume

Heart Rate and Muscle Oxygenation Kinetics During Dynamic Constant Load Intermittent Breath-Holds

Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving

Contact Info

Product

Resources

About