Evaluation of breath holding in hypercapnia as a simple clinical test of respiratory chemosensitivity.

Stanley, N. N.; Cunningham, E L; Altose, Murray D.; Kelsen, Steven G.; Levinson, Richard S.; Cherniack, Neil S.

doi:10.1136/thx.30.3.337

Cited by 20 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several adaptations in CO 2 sensitivity have been reported in divers [11,18,20,22,23], but non-chemical factor modifications have not been demonstrated to date. The aim of this study was to dissociate chemical and non-chemical stimuli and to evaluate non-chemical factor adaptations in divers and non-divers by assessing the modifications in respiratory centre activity in response to hypercapnic stimuli and for different BHT.…”

Section: Introductionmentioning

confidence: 91%

Breath-holding time: effects of non-chemical factors in divers and non-divers

Delapille¹,

Vérin

Tourny-Chollet³

et al. 2001

Pfl�gers Archiv European Journal of Physiology

View full text Add to dashboard Cite

Two main factors (chemical and non-chemical factors) are involved in the determination of breath-holding time (BHT). Earlier studies have shown that chemical factors can be modified by training. The aim of this study was to establish whether BHT can be lengthened or shortened by changes in non-chemical factors according to the degree of training of the divers. Hyperoxic hypercapnic rebreathing challenges interrupted by different periods of voluntary apnoea (20, 40 and 50 s) were performed by divers (n=8) and non-divers (n=6). The relationships between ventilation (VE) and end-tidal PCO2 and mean inspiratory flow (VT/TI) where VT is the tidal volume and TI the inspiration time) and end-tidal PCO2 were measured before (pre) and after (post) apnoea for each population. The slopes of these linear regressions (VEs and VT/TI,s, respectively) reflected respiratory centre activity. VFs-post and VT/TIs-post increased with BHT and were higher in the non-divers than in divers. There were no significant differences between VFs-pre and VFs-post or between VT/TIs,-pre and VT/TIs-post in divers for all BHT. However, in non-divers, significant differences between pre and post values appeared at 20, 40 and 50 s for VT/TI,s and at 40 and 50 s for VEs. Non-chemical factorswere obtained by calculating the differences between pre and post values and were different at 20 and 40 s for VEs (P<0.05) and for all BHT for VT/TI,s (P<0.05). The non-chemical factors increased significantly with BHT and were higher in the non-divers. These adaptations in divers may modify the breath-hold breaking point and consequently increase BHT.

show abstract

Section: Introductionmentioning

confidence: 91%

Breath-holding time: effects of non-chemical factors in divers and non-divers

Delapille¹,

Vérin

Tourny-Chollet³

et al. 2001

Pfl�gers Archiv European Journal of Physiology

View full text Add to dashboard Cite

show abstract

“…Previously, investigators have demonstrated that chemoreflex sensitivity (a key determinant of loop gain) during wakefulness – measured via CO 2 rebreathing (Stanley et al . ) or dynamic CO 2 administration (Trembach & Zabolotskikh, ) – can be estimated simply by measuring how long participants can voluntarily hold their breath for (“maximal breath‐hold duration”). Conceptually, during a breath‐hold, participants generate their own hypoxia–hypercapnia at a rate determined by the plant (e.g.…”

Section: Introductionmentioning

confidence: 99%

Breath‐holding as a means to estimate the loop gain contribution to obstructive sleep apnoea

Messineo

Taranto‐Montemurro

Azarbarzin

et al. 2018

The Journal of Physiology

View full text Add to dashboard Cite

Increased "loop gain" of the ventilatory control system promotes obstructive sleep apnoea (OSA) in some patients and offers an avenue for more personalized treatment, yet diagnostic tools for directly measuring loop gain in the clinical setting are lacking. Here we test the hypothesis that elevated loop gain during sleep can be recognized using voluntary breath-hold manoeuvres during wakefulness. Twenty individuals (10 OSA, 10 controls) participated in a single overnight study with voluntary breath-holding manoeuvres performed during wakefulness. We assessed (1) maximal breath-hold duration, and (2) the ventilatory response to 20 s breath-holds. For comparison, gold standard loop gain values were obtained during non-rapid eye movement (non-REM) sleep using the ventilatory response to 20 s pulses of hypoxic-hypercapnic gas (6% CO -14% O , mimicking apnoea). Continuous positive airway pressure (CPAP) was used to maintain airway patency during sleep. Additional measurements included gold standard loop gain measurement during wakefulness and steady-state loop gain measurement during sleep using CPAP dial-ups. Higher loop gain during sleep was associated with (1) a shorter maximal breath-hold duration (r = 0.49, P < 0.001), and (2) a larger ventilatory response to 20 s breath-holds during wakefulness (second breath; r = 0.50, P < 0.001); together these factors combine to predict high loop gain (receiver operating characteristic area-under-curve: 92%). Gold standard loop gain values were remarkably similar during wake and non-REM sleep. The results show that elevated loop gain during sleep can be identified using simple breath-holding manoeuvres performed during wakefulness. This may have implications for personalizing OSA treatment.

show abstract

“…The suprapontine origin of this phenomenon, generally referred to as "wakefulness drive to breathe," is confirmed by its disappearance in patients with forebrain lesions (44). Conversely, when the drive to breathe is increased to meet the metabolic needs of the body, it can become increasingly difficult for suprapontine ventilatory commands to override the automatic ones (6,52,62), even though hypercapnia facilitates the response of the diaphragm to corticospinal inputs (64). How cortical and subcortical commands interfere thus depends on the prevailing CO 2 levels (44,58,64).…”

mentioning

confidence: 97%

Effects of hypercapnia and hypocapnia on ventilatory variability and the chaotic dynamics of ventilatory flow in humans

Fiamma¹,

Straus²,

Thibault³

et al. 2007

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

In humans, lung ventilation exhibits breath-to-breath variability and dynamics that are nonlinear, complex, sensitive to initial conditions, unpredictable in the long-term, and chaotic. Hypercapnia, as produced by the inhalation of a CO(2)-enriched gas mixture, stimulates ventilation. Hypocapnia, as produced by mechanical hyperventilation, depresses ventilation in animals and in humans during sleep, but it does not induce apnea in awake humans. This emphasizes the suprapontine influences on ventilatory control. How cortical and subcortical commands interfere thus depend on the prevailing CO(2) levels. However, CO(2) also influences the variability and complexity of ventilation. This study was designed to describe how this occurs and to test the hypothesis that CO(2) chemoreceptors are important determinants of ventilatory dynamics. Spontaneous ventilatory flow was recorded in eight healthy subjects. Breath-by-breath variability was studied through the coefficient of variation of several ventilatory variables. Chaos was assessed with the noise titration method (noise limit) and characterized with numerical indexes [largest Lyapunov exponent (LLE), sensitivity to initial conditions; Kolmogorov-Sinai entropy (KSE), unpredictability; and correlation dimension (CD), irregularity]. In all subjects, under all conditions, a positive noise limit confirmed chaos. Hypercapnia reduced breathing variability, increased LLE (P = 0.0338 vs. normocapnia; P = 0.0018 vs. hypocapnia), increased KSE, and slightly reduced CD. Hypocapnia increased variability, decreased LLE and KSE, and reduced CD. These results suggest that chemoreceptors exert a strong influence on ventilatory variability and complexity. However, complexity persists in the quasi-absence of automatic drive. Ventilatory variability and complexity could be determined by the interaction between the respiratory central pattern generator and suprapontine structures.

show abstract

Evaluation of breath holding in hypercapnia as a simple clinical test of respiratory chemosensitivity.

Cited by 20 publications

References 22 publications

Breath-holding time: effects of non-chemical factors in divers and non-divers

Breath-holding time: effects of non-chemical factors in divers and non-divers

Breath‐holding as a means to estimate the loop gain contribution to obstructive sleep apnoea

Effects of hypercapnia and hypocapnia on ventilatory variability and the chaotic dynamics of ventilatory flow in humans

Contact Info

Product

Resources

About