American Journal of Respiratory and Critical Care Medicine Vol 165. pp. 1251-1260, (2002)
© 2002 American Thoracic Society
Effect of Ventilatory Drive on Carbon Dioxide Sensitivity below Eupnea during Sleep
Hideaki Nakayama,
Curtis A. Smith,
Joshua R. Rodman,
James B. Skatrud and
Jerome A. Dempsey
The John Rankin Laboratory of Pulmonary Medicine, Departments of Population Health Sciences and Medicine, University of Wisconsin School of Medicine; and Middleton Memorial Veterans Hospital, Madison, Wisconsin
Correspondence and requests for reprints should be addressed to Dr. J. A. Dempsey, The John Rankin Laboratory of Pulmonary Medicine, 504 North Walnut Street, Madison, WI 53705. E-mail: jdempsey{at}facstaff.wisc.edu
We determined the effects of changing ventilatory stimuli on the hypocapnia-induced apneic and hypopneic thresholds in sleeping dogs. End-tidal carbon dioxide pressure (PETCO2) was gradually reduced during non–rapid eye movement sleep by increasing tidal volume with pressure support mechanical ventilation, causing a reduction in diaphragm electromyogram amplitude until apnea/periodic breathing occurred. We used the reduction in PETCO2 below spontaneous breathing required to produce apnea ( PETCO2) as an index of the susceptibility to apnea. PETCO2 was -5 mm Hg in control animals and changed in proportion to background ventilatory drive, increasing with metabolic acidosis (-6.7 mm Hg) and nonhypoxic peripheral chemoreceptor stimulation (almitrine; -5.9 mm Hg) and decreasing with metabolic alkalosis (-3.7 mm Hg). Hypoxia was the exception; PETCO2 narrowed (-4.1 mm Hg) despite the accompanying hyperventilation. Thus, hyperventilation and hypocapnia, per se, widened the PETCO2 thereby protecting against apnea and hypopnea, whereas reduced ventilatory drive and hypoventilation narrowed the PETCO2 and increased the susceptibility to apnea. Hypoxia sensitized the ventilatory responsiveness to CO2 below eupnea and narrowed the PETCO2; this effect of hypoxia was not attributable to an imbalance between peripheral and central chemoreceptor stimulation, per se. We conclude that the PETCO2 and the ventilatory sensitivity to CO2 between eupnea and the apneic threshold are changeable in the face of variations in the magnitude, direction, and/or type of ventilatory stimulus, thereby altering the susceptibility for apnea, hypopnea, and periodic breathing in sleep.
Key Words: sleep apnea • chemoreceptors • hyperventilation • hypoventilation • apneic/hypopneic thresholds
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Copyright © 2002 American Thoracic Society
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