Nonrandom Variability of Respiration During Sleep in Healthy Humans

Rostig, Sven; Kantelhardt, Jan W.; Penzel, Thomas; Cassel, Werner; Peter, J. H.; Vogelmeier, Claus; Becker, Heinrich F.; Jerrentrup, Andreas

doi:10.1093/sleep/28.4.411

Cited by 50 publications

(42 citation statements)

References 48 publications

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“…We also found distinct differences in breath size and timing with sleep stage consistent with what has been reported previously (Rostig et al, 2005; Schumann et al) During NREM sleep, the overall variability of Vt and Ti, as measured by CV, is decreased as compared to REM. Furthermore, α 1 and α 2 of Vt are larger with wake and REM sleep as compared to NREM sleep, similar to what is seen in resistance.…”

Section: Discussionsupporting

confidence: 91%

Variability of respiratory mechanics during sleep in overweight and obese subjects with and without asthma

Campana

Owens

Butler

et al. 2013

Respiratory Physiology & Neurobiology

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Variability of respiration may provide information regarding disease states. We sought to characterize variability of ventilation and resistance in healthy and asthma, to determine how respiratory control may be altered in sleep and with bi-level positive airway pressure (BPAP). Overweight and obese subjects with and without asthma were studied during sleep at baseline and with BPAP, while measuring respiratory system resistance (Rrs) continuously. Stable periods (>20min) of wake, NREM, and REM sleep were identified and correlation metrics of respiratory parameters were calculated, including coefficient of variation (CV). Variability of Rrs was also characterized over short time scales (20 breaths) during sleep and defined as either “leading to arousal” or “not leading to arousal”. Data from 10 control and 10 subjects with asthma were analyzed. CV of Rrs was decreased in asthma at baseline (p<0.001) and decreased on BPAP as compared to baseline (p<0.001). Long time scale correlations were found in respiratory parameters, but the degree of correlations was decreased from wake to sleep (p<0.05). The variance and CV of Rrs was increased preceding an arousal from sleep at baseline; however, during BPAP, the CV was decreased and was not increased preceding arousals. At baseline, resistance was greater in those with asthma, but variability was smaller. BPAP reduced both resistance and overall variability. We conclude that the BPAP-induced decrease in variability may indicate that those with asthma are more likely to remain in a low resistance state, and that low resistance variability may reduce arousals from sleep.

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Section: Discussionsupporting

confidence: 91%

Variability of respiratory mechanics during sleep in overweight and obese subjects with and without asthma

Campana

Owens

Butler

et al. 2013

Respiratory Physiology & Neurobiology

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“…Consequently, ventilatory fluctuations can be larger as a consequence of increased loop gain or increased noise. Thus, two distinct phenotypes of excessive ventilatory variability can be described: those driven largely by hypersensitive chemoreflex feedback (normal biological noise levels), and those with increased biological noise [i.e., ataxic opioid-induced ventilatory fluctuations (36) or ventilatory fluctuations in rapid-eye movement sleep (37)]. …”

Section: Original Articlementioning

confidence: 99%

Resonance as the Mechanism of Daytime Periodic Breathing in Patients with Heart Failure

Sands

Mebrate

Edwards

et al. 2017

Am J Respir Crit Care Med

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Rationale: In patients with chronic heart failure, daytime oscillatory breathing at rest is associated with a high risk of mortality. Experimental evidence, including exaggerated ventilatory responses to CO 2 and prolonged circulation time, implicates the ventilatory control system and suggests feedback instability (loop gain . 1) is responsible. However, daytime oscillatory patterns often appear remarkably irregular versus classic instability (Cheyne-Stokes respiration), suggesting our mechanistic understanding is limited.Objectives: We propose that daytime ventilatory oscillations generally result from a chemoreflex resonance, in which spontaneous biological variations in ventilatory drive repeatedly induce temporary and irregular ringing effects. Importantly, the ease with which spontaneous biological variations induce irregular oscillations (resonance "strength") rises profoundly as loop gain rises toward 1. We tested this hypothesis through a comparison of mathematical predictions against actual measurements in patients with heart failure and healthy control subjects.Methods: In 25 patients with chronic heart failure and 25 control subjects, we examined spontaneous oscillations in ventilation and separately quantified loop gain using dynamic inspired CO 2 stimulation.Measurements and Main Results: Resonance was detected in 24 of 25 patients with heart failure and 18 of 25 control subjects. With increased loop gain-consequent to increased chemosensitivity and delay-the strength of spontaneous oscillations increased precipitously as predicted (r = 0.88), yielding larger (r = 0.78) and more regular (interpeak interval SD, r = 20.68) oscillations (P , 0.001 for all, both groups combined).Conclusions: Our study elucidates the mechanism underlying daytime ventilatory oscillations in heart failure and provides a means to measure and interpret these oscillations to reveal the underlying chemoreflex hypersensitivity and reduced stability that foretells mortality in this population.Keywords: instability; loop gain; Cheyne-Stokes respiration; heart failure; chemosensitivity

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“…30 For each sleep stage, the squared fluctuation F 2 (s) was calculated for each segment. Then the F 2 (s) values of all segments of each subject for that sleep stage were averaged.…”

mentioning

confidence: 99%

Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients

Nguyen

Kim

Grunstein

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Methadone maintenance treatment (MMT) patients have a high prevalence of central sleep apnea and ataxic breathing related to damage to central respiratory rhythm control. However, the quantification of sleep apnea indices requires laborious manual scoring, and ataxic breathing pattern is subjectively judged by visual pattern recognition. This study proposes a semi-automated technique to characterize respiratory variability in MMT patients. Methods: Polysomnography, blood, and functional outcomes of sleep questionnaire (FOSQ) from 50 MMT patients and 20 healthy subjects with matched age, sex, and body mass index, were analyzed. Inter-breath intervals (IBI) were extracted from the nasal cannula pressure signal. Variability of IBI over 100 breaths was quantified by standard deviation (SD), coefficient of variation (CV), and scaling exponent (α) from detrended fluctuation analysis. The relationships between these variability measures and blood methadone concentration, central sleep apnea index (CAI), apnea-hypopnea index (AHI), and clinical outcome (FOSQ), were then examined. Results: MMT patients had significantly higher SD and CV during all sleep stages. During NREM sleep, SD and CV were correlated with blood methadone concentration (Spearman R = 0.52 and 0.56, respectively; p < 0.01). SD and CV were also correlated with CAI (R = 0.63 and 0.71, p < 0.001, respectively), and AHI (R = 0.45 and 0.58, p < 0.01, respectively). Only α showed significant correlation with FOSQ (R = −0.33, p < 0.05). Conclusions: MMT patients have a higher respiratory variability during sleep than healthy controls. Semi-automated variability measures are related to apnea indices obtained by manual scoring and may provide a new approach to quantify opioid-related sleep-disordered breathing.

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Nonrandom Variability of Respiration During Sleep in Healthy Humans

Cited by 50 publications

References 48 publications

Variability of respiratory mechanics during sleep in overweight and obese subjects with and without asthma

Variability of respiratory mechanics during sleep in overweight and obese subjects with and without asthma

Resonance as the Mechanism of Daytime Periodic Breathing in Patients with Heart Failure

Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients

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