1
|
Rosa CH, Monteiro CP, Barata C, Espada MC, Valamatos MJ, Bento A, Minhalma RJ, Reis JF. Cardiorespiratory and muscle oxygenation responses to voluntary hypoventilation at low lung volume in upper body repeated sprints. Eur J Appl Physiol 2024:10.1007/s00421-024-05569-1. [PMID: 39138688 DOI: 10.1007/s00421-024-05569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To investigate the impact of voluntary hypoventilation at low lung volumes (VHL) during upper body repeated sprints (RS) on performance, metabolic markers and muscle oxygenation in Brazilian Jiu-Jitsu (BJJ) athletes. METHODS Eighteen male well-trained athletes performed two randomized RS sessions, one with normal breathing (RSN) and another with VHL (RS-VHL), on an arm cycle ergometer, consisting of two sets of eight all-out 6-s sprints performed every 30 s. Peak (PPO), mean power output (MPO), and RS percentage decrement score were calculated. Arterial oxygen saturation (SpO2), heart rate (HR), gas exchange, and muscle oxygenation of the long head of the triceps brachii were continuously recorded. Blood lactate concentration ([La]) was measured at the end of each set. Bench press throw peak power (BPPP) was recorded before and after the RS protocol. RESULTS Although SpO2 was not different between conditions, PPO and MPO were significantly lower in RS-VHL. V ˙ E, HR, [La], and RER were lower in RS-VHL, and VO2 was higher in RS-VLH than in RSN. Muscle oxygenation was not different between conditions nor was its pattern of change across the RS protocol influenced by condition. [La] was lower in RS-VHL than in RSN after both sets. CONCLUSION Performance was significantly lower in RS-VHL, even though SPO2 was not consistent with hypoxemia. However, the fatigue index was not significantly affected by VHL, nor was the neuromuscular upper body power after the RS-VHL protocol. Additionally, [La] was lower, and oxygen consumption was higher in RS-VHL, suggesting a higher aerobic contribution in this condition.
Collapse
Affiliation(s)
- Cristóvão H Rosa
- Laboratory of Physiology and Biochemistry of Exercise, Faculdade de Motricidade Humana, Universidade de Lisboa, Oeiras, Portugal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina P Monteiro
- Laboratory of Physiology and Biochemistry of Exercise, Faculdade de Motricidade Humana, Universidade de Lisboa, Oeiras, Portugal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Cláudia Barata
- Laboratory of Physiology and Biochemistry of Exercise, Faculdade de Motricidade Humana, Universidade de Lisboa, Oeiras, Portugal
| | - Mário C Espada
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Instituto Politécnico de Setúbal, Escola Superior de Educação, Setúbal, Portugal
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), Rio Maior, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
- Life Quality Research Centre (CIEQV), Setúbal, Portugal
| | - Maria João Valamatos
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Neuromuscular Research Laboratory, Faculdade Motricidade Humana, Universidade Lisboa, Oeiras, Portugal
| | - André Bento
- Laboratory of Physiology and Biochemistry of Exercise, Faculdade de Motricidade Humana, Universidade de Lisboa, Oeiras, Portugal
| | - Ricardo J Minhalma
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), Rio Maior, Portugal
- Escola Superior de Educacao e Comunicacao, Universidade do Algarve, Faro, Portugal
| | - Joana Filipa Reis
- Laboratory of Physiology and Biochemistry of Exercise, Faculdade de Motricidade Humana, Universidade de Lisboa, Oeiras, Portugal.
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.
- Portugal Football School, Portuguese Football Federation, FPF, Cruz-Quebrada, Portugal.
| |
Collapse
|
2
|
Strapazzon G, Taboni A, Dietrichs ES, Luks AM, Brugger H. Avalanche burial pathophysiology - a unique combination of hypoxia, hypercapnia and hypothermia. J Physiol 2024. [PMID: 39073871 DOI: 10.1113/jp284607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/17/2024] [Indexed: 07/30/2024] Open
Abstract
For often unclear reasons, the survival times of critically buried avalanche victims vary widely from minutes to hours. Individuals can survive and sustain organ function if they can breathe under the snow and maintain sufficient delivery of oxygen and efflux of carbon dioxide. We review the physiological responses of humans to critical avalanche burial, a model which shares similarities and differences with apnoea and accidental hypothermia. Within a few minutes of burial, an avalanche victim is exposed to hypoxaemia and hypercapnia, which have important effects on the respiratory and cardiovascular systems and pose a major threat to the central nervous system. As burial time increases, an avalanche victim also develops hypothermia. Despite progressively reduced metabolism, reduced oxygen and increased carbon dioxide tensions may exacerbate the pathophysiological consequences of hypothermia. Hypercapnia seems to be the main cause of cardiovascular instability, which, in turn, is the major reason for reduced cerebral oxygenation despite reductions in cerebral metabolic activity caused by hypothermia. 'Triple H syndrome' refers to the interaction of hypoxia, hypercapnia and hypothermia in a buried avalanche victim. Future studies should investigate how the respiratory gases entrapped in the porous snow structure influence the physiological responses of buried individuals and how haemoconcentration, blood viscosity and cell deformability affect blood flow and oxygen delivery. Attention should also be devoted to identifying strategies to prolong avalanche survival by either mitigating hypoxia and hypercapnia or reducing core temperature so that neuroprotection occurs before the onset of cerebral hypoxia.
Collapse
Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Medicine - DIMEM, University of Padova, Padova, Italy
| | - Anna Taboni
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | | | - Andrew M Luks
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| |
Collapse
|
3
|
Wendi W, Dongzhe W, Hao W, Yongjin S, Xiaolin G. Effect of dry dynamic apnea on aerobic power in elite rugby athletes: a warm-up method. Front Physiol 2024; 14:1269656. [PMID: 38292448 PMCID: PMC10824898 DOI: 10.3389/fphys.2023.1269656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
Objective: While long-term dynamic breath-holding training has been extensively studied to enhance cardiopulmonary function in athletes, limited research has explored the impact of a single breath-holding session on subsequent athletic capacity. In addition, Dry Dynamic Apnea (DA) has a more immediate physiological response than wet and static breath-holding. This study aims to assess the immediate effects of a single session of DA on the aerobic power and hematological parameters of elite athletes. Methods: Seventeen elite male rugby athletes (average age 23.5 ± 1.8) participated in this study. Two warm-up protocols were employed prior to incremental exercise: a standard warm-up (10 min of no-load pedaling) and a DA warm-up (10 min of no-load pedaling accompanied by six maximum capacity breath holds, with 30 s between each breath hold). Fingertip blood indicators were measured before and after warm-up. The incremental exercise test assessed aerobic parameters with self-regulation applied throughout the study. Results: Compared to the baseline warm-up, the DA warm-up resulted in a significant increase in VO2peak from 3.14 to 3.38 L/min (7.64% change, p < 0.05). HRmax increased from 170 to 183 bpm (7.34% change, p < 0.05), and HRpeak increased from 169 to 182 bpm (7.52% change, p < 0.05). Hematocrit and hemoglobin showed differential changes between the two warm-up methods (PHematocrit = 0.674; Phemoglobin = 0.707). Conclusion: This study investigates how DA influences physiological factors such as spleen contraction, oxygen uptake, and sympathetic nerve activation compared to traditional warm-up methods. Immediate improvements in aerobic power suggest reduced vagus nerve stimulation, heightened sympathetic activity, and alterations in respiratory metabolism induced by the voluntarily hypoxia-triggered warm-up. Further research is warranted to comprehensively understand these physiological responses and optimize warm-up strategies for elite athletic performance.
Collapse
Affiliation(s)
- Wang Wendi
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Wu Dongzhe
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Wang Hao
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Shi Yongjin
- Department of Sports and Arts, China Agricultural University, Beijing, China
| | - Gao Xiaolin
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| |
Collapse
|
4
|
Poiret C, Noulhiane M, Clua E, Lemaître F. Breath-hold diving strategies to avoid loss of consciousness: speed is the key factor. Sports Biomech 2024; 23:44-57. [PMID: 33272108 DOI: 10.1080/14763141.2020.1820073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/28/2020] [Indexed: 10/22/2022]
Abstract
The aim of this study was to investigate the impact of breath-hold diving strategies regarding loss of consciousness (LOC). Three international competitions were examined through video in constant weight diving with (CWT) or without (CNF) fins. We analysed three breath-hold parameters (time, speed, and movements count) for the following phases: active descent, passive descent, turning, and ascent. Divers who had LOC during CNF were slower in the active descent phase, faster in the passive descent phase with a longer turn, and slower in the ascent phase than divers who did not have LOC. They also had lower amplitude and higher frequency. Men were deeper (72.9 m vs. 56.3 m) for a longer dive time (181.1 s vs. 154.6 s), faster, with a greater amplitude than women. In CWT, divers with an LOC had longer dive times (197 s vs. 167 s) with a faster active descent phase. Men had lower amplitude and greater frequency than women. This is the first study showing that breath-hold divers undergoing an LOC event shown differences in efficiency during CWT and CNF regarding velocities, amplitudes, and frequencies. In conclusion, our results suggest that the speed parameter during active descent phase influence the LOC.
Collapse
Affiliation(s)
- Clément Poiret
- Centre for the Study of Transformations of Physical and Sports Activities, Faculty of Sports Sciences, University of Rouen, Rouen, France
- Translational and Applicative Neuroimaging Research Unit, French Alternative Energies and Atomic Energy Commission, University of Paris-Saclay, Gif-sur-Yvette, France
- Mixed Research Unit 1141, Neurodiderot University, Paris, France
| | - Marion Noulhiane
- Translational and Applicative Neuroimaging Research Unit, French Alternative Energies and Atomic Energy Commission, University of Paris-Saclay, Gif-sur-Yvette, France
- Mixed Research Unit 1141, Neurodiderot University, Paris, France
| | - Eric Clua
- Centre for Insular Research and Observatory of the Environment, Moorea, French Polynesia
| | - Frédéric Lemaître
- Centre for the Study of Transformations of Physical and Sports Activities, Faculty of Sports Sciences, University of Rouen, Rouen, France
| |
Collapse
|
5
|
Mulder E, Staunton C, Sieber A, Schagatay E. Unlocking the depths: multiple factors contribute to risk for hypoxic blackout during deep freediving. Eur J Appl Physiol 2023; 123:2483-2493. [PMID: 37300699 PMCID: PMC10615935 DOI: 10.1007/s00421-023-05250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To examine the effect of freediving depth on risk for hypoxic blackout by recording arterial oxygen saturation (SpO2) and heart rate (HR) during deep and shallow dives in the sea. METHODS Fourteen competitive freedivers conducted open-water training dives wearing a water-/pressure proof pulse oximeter continuously recording HR and SpO2. Dives were divided into deep (> 35 m) and shallow (10-25 m) post-hoc and data from one deep and one shallow dive from 10 divers were compared. RESULTS Mean ± SD depth was 53 ± 14 m for deep and 17 ± 4 m for shallow dives. Respective dive durations (120 ± 18 s and 116 ± 43 s) did not differ. Deep dives resulted in lower minimum SpO2 (58 ± 17%) compared with shallow dives (74 ± 17%; P = 0.029). Overall diving HR was 7 bpm higher in deep dives (P = 0.002) although minimum HR was similar in both types of dives (39 bpm). Three divers desaturated early at depth, of which two exhibited severe hypoxia (SpO2 ≤ 65%) upon resurfacing. Additionally, four divers developed severe hypoxia after dives. CONCLUSIONS Despite similar dive durations, oxygen desaturation was greater during deep dives, confirming increased risk of hypoxic blackout with increased depth. In addition to the rapid drop in alveolar pressure and oxygen uptake during ascent, several other risk factors associated with deep freediving were identified, including higher swimming effort and oxygen consumption, a compromised diving response, an autonomic conflict possibly causing arrhythmias, and compromised oxygen uptake at depth by lung compression possibly leading to atelectasis or pulmonary edema in some individuals. Individuals with elevated risk could likely be identified using wearable technology.
Collapse
Affiliation(s)
- Eric Mulder
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Kunskapens Väg 8, 831 25, Östersund, Sweden.
| | - Craig Staunton
- Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - Arne Sieber
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Kunskapens Väg 8, 831 25, Östersund, Sweden
- Oxygen Scientific GmbH, Graz, Austria
| | - Erika Schagatay
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Kunskapens Väg 8, 831 25, Östersund, Sweden
- Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| |
Collapse
|
6
|
Carotid body stimulation as a potential intervention in sudden death in epilepsy. Epilepsy Behav 2022; 136:108918. [PMID: 36202052 PMCID: PMC10187768 DOI: 10.1016/j.yebeh.2022.108918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate carotid body (CB) mechanisms related to sudden death during seizure. Ictal activation of oxygen-conserving reflexes (OCRs) can trigger fatal cardiorespiratory collapse in seizing rats, which presents like human sudden unexpected death in epilepsy (SUDEP). The CB is strongly implicated in OCR pathways; we hypothesize that modulating CB activity will provide insight into these mechanisms of death. METHODS Long-Evans rats were anesthetized with urethane. Recordings included: electrocorticography, electrocardiography, respiration via nasal thermocouple, and blood pressure (BP). The mammalian diving reflex (MDR) was activated by cold water delivered through a nasal cannula. Reflex and stimulation trials were repeated up to 16 times (4 pre-intervention, 12 post-intervention) or until death. In some animals, one or both carotid bodies were denervated. In some animals, the CB was electrically stimulated, both with and without MDR. Seizures were induced with kainic acid (KA). RESULTS Animals without seizure and with no CB modulation survived all reflexes. Non-seizing animals with CB denervation survived 7.1 ± 5.4 reflexes before death, and only 1 of 7 survived past the 12-trial threshold. Electrical CB stimulation without seizure and without reflex caused significant tachypnea and hypotension. Electrical CB stimulation with seizure and without reflex required higher amplitudes to replicate the physiological responses seen outside seizure. Seizing animals without CB intervention survived 3.2 ± 3.6 trials (per-reflex survival rate 42.0% ± 44.4%), and 0 of 7 survived past the 12-trial threshold. Seizing animals with electrical CB stimulation survived 10.5 ± 4.7 ictal trials (per-reflex survival rate 86.3% ± 35.0%), and 6 of 8 survived past the 12-trial threshold. SIGNIFICANCE These results suggest that, during seizure, the ability of the CB to stimulate a restart of respiration is impaired. The CB and its afferents may be relevant to fatal ictal apnea and SUDEP in humans, and CB stimulation may be a relevant intervention technique in these deaths.
Collapse
|
7
|
de Asís-Fernández F, Sereno D, Turner AP, González-Mohíno F, González-Ravé JM. Effects of apnoea training on aerobic and anaerobic performance: A systematic review and meta-analysis. Front Physiol 2022; 13:964144. [PMID: 36237527 PMCID: PMC9551563 DOI: 10.3389/fphys.2022.964144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Trained breath-hold divers have shown physiological adaptations that might improve athletes’ aerobic and anaerobic performance.Objective This study aimed to systematically review the scientific literature and perform a meta-analysis to assess the effects of voluntary apnoea training on markers of anaerobic and aerobic performance, such as blood lactate and VO2max.Methods A literature search on three databases (Web of Science, PubMed and SCOPUS) was conducted in March 2022. The inclusion criteria were 1) peer-reviewed journal publication; 2) clinical trials; 3) healthy humans; 4) effects of apnoea training; 5) variables included markers of aerobic or anaerobic performance, such as lactate and VO2max.Results 545 manuscripts were identified following database examination. Only seven studies met the inclusion criteria and were, therefore, included in the meta-analysis. 126 participants were allocated to either voluntary apnoea training (ApT; n = 64) or normal breathing (NB; n = 63). Meta-analysis on the included studies demonstrated that ApT increased the peak blood lactate concentration more than NB (MD = 1.89 mmol*L−1 [95% CI 1.05, 2.73], z = 4.40, p < 0.0001). In contrast, there were no statistically significant effects of ApT on VO2max (MD = 0.89 ml*kg−1*min−1 [95% CI −1.23, 3.01], z = 0.82, p = 0.41).Conclusion ApT might be an alternative strategy to enhace anaerobic performance associated with increased maximum blood lactate; however, we did not find evidence of ApT effects on physiological aerobic markers, such as VO2max.Systematic Review Registration: [PRISMA], identifier [registration number].
Collapse
Affiliation(s)
- Francisco de Asís-Fernández
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Breatherapy Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Sereno
- Breatherapy Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Sports Training Laboratory, Faculty of Sports Sciences, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Anthony P. Turner
- Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Fernando González-Mohíno
- Sports Training Laboratory, Faculty of Sports Sciences, Universidad de Castilla-La Mancha, Toledo, Spain
- Facultad de Ciencias de la Vida y de la Naturaleza, Universidad Nebrija, Madrid, Spain
- *Correspondence: Fernando González-Mohíno,
| | - José María González-Ravé
- Sports Training Laboratory, Faculty of Sports Sciences, Universidad de Castilla-La Mancha, Toledo, Spain
| |
Collapse
|
8
|
Vitali L, Raffi M, Piras A. Acute Cardiovascular and Metabolic Effects of Different Warm-Up Protocols on Dynamic Apnea. J Sports Sci Med 2022; 21:298-307. [PMID: 35719233 PMCID: PMC9157517 DOI: 10.52082/jssm.2022.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to evaluate the acute physiological response to different warm-up protocols on the dynamic apnea performance. The traditional approach, including a series of short-mid dives in water (WET warm-up), was compared to a more recent strategy, consisting in exercises performed outside the water (DRY warm-up). Nine athletes were tested in two different sessions, in which the only difference was the warm-up executed before 75m of dynamic apnea. Heart rate variability, baroreflex sensitivity, hemoglobin, blood lactate and the rate of perceived exertion were recorded and analyzed. With respect to WET condition, DRY showed lower lactate level before the dive (1.93 vs. 2.60 mmol/L, p = 0.006), higher autonomic indices and lower heart rate during the subsequent dynamic apnea. A significant correlation between lactate produced during WET with the duration of the subsequent dynamic apnea, suggests that higher lactate levels could affect the dive performance (72 vs. 70 sec, p = 0.028). The hemoglobin concentration and the rate of perceived exertion did not show significant differences between conditions. The present findings partially support the claims of freediving athletes who adopt the DRY warm-up, since it induces a more pronounced diving response, avoiding higher lactate levels and reducing the dive time of a dynamic apnea.
Collapse
Affiliation(s)
- Luca Vitali
- Department for Life Quality Studies, University of Bologna, Italy
| | - Milena Raffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Alessandro Piras
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| |
Collapse
|
9
|
Reiter C, Reiter U, Kräuter C, Nizhnikava V, Greiser A, Scherr D, Schmidt A, Fuchsjäger M, Reiter G. Differences in left ventricular and left atrial function assessed during breath-holding and breathing. Eur J Radiol 2021; 141:109756. [PMID: 34023727 DOI: 10.1016/j.ejrad.2021.109756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/07/2021] [Accepted: 05/01/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze differences in systolic and diastolic left ventricular (LV) as well as left atrial (LA) function parameters obtained from identical cardiac magnetic resonance (MR) imaging techniques during inspiratory breath-holding and breathing (breath-hold to breathing differences). METHOD 56 subjects without signs of heart failure (23/33 male/female, age 58 ± 14 years) underwent 3 T MR cine real-time and transmitral phase contrast imaging with the same spatial and temporal resolution during inspiratory breath-holding and free breathing. LV and LA volumetric function parameters were derived from segmentation of cine series, transmitral peak velocities and early-diastolic myocardial peak velocity from phase contrast series. Corresponding breath-hold and breathing parameters were compared by Bland-Altman analysis; repeatability of breath-hold and breathing measurements was quantified by variance component analysis. p < 0.05 was regarded as statistically significant. RESULTS Mean differences between results obtained during inspiratory breath-holding vs. breathing were significant for LV volumetric function (end-diastolic volume=-7 mL, p = 0.002; end-systolic volume=-7 mL, p < 0.001; ejection fraction = 3 %, p < 0.001; peak ejection rate = 22 mL/s, p = 0.002; early-diastolic peak filling rate=-34 mL/s, p = 0.025), LA volumetric function (maximum volume=-6 mL, p < 0.001; total ejection fraction=-4%, p < 0.001; active ejection fraction=-2%, p = 0.013; before contraction ejection fraction=-4%, p < 0.001) and early-diastolic velocities (transmitral=-6 cm/s, p < 0.001; tissue velocity=-1.8 cm/s, p < 0.001). Standard deviations of breath-hold-to-breathing differences exceeded the corresponding repeatabilities of breath-hold and breathing measurements. CONCLUSIONS Systolic and diastolic LV and LA function parameters acquired during inspiratory breath-holding and breathing differ, and large inter-individual breath-hold-to-breathing variations are possible. Thus, the breathing state should be taken into account, especially when comparing results in patient follow-up acquired in different respiratory states.
Collapse
Affiliation(s)
- Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria; Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria; Institute of Medical Engineering, Graz University of Technology, Austria.
| | - Volha Nizhnikava
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
| | - Andreas Greiser
- Research and Development, Siemens Healthcare GmbH, Erlangen, Germany.
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria; Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria.
| |
Collapse
|
10
|
Baroreflex responses during dry resting and exercise apnoeas in air and pure oxygen. Eur J Appl Physiol 2020; 121:539-547. [PMID: 33151437 PMCID: PMC7862076 DOI: 10.1007/s00421-020-04544-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/26/2020] [Indexed: 12/02/2022]
Abstract
Purpose We analysed the characteristics of arterial baroreflexes during the first phase of apnoea (φ1). Methods 12 divers performed rest and exercise (30 W) apnoeas (air and oxygen). We measured beat-by-beat R-to-R interval (RRi) and mean arterial pressure (MAP). Mean RRi and MAP values defined the operating point (OP) before (PRE-ss) and in the second phase (φ2) of apnoea. Baroreflex sensitivity (BRS, ms·mmHg−1) was calculated with the sequence method. Results In PRE-ss, BRS was (median [IQR]): at rest, 20.3 [10.0–28.6] in air and 18.8 [13.8–25.2] in O2; at exercise 9.2[8.4–13.2] in air and 10.1[8.4–13.6] in O2. In φ1, during MAP decrease, BRS was lower than in PRE-ss at rest (6.6 [5.3–11.4] in air and 7.7 [4.9–14.3] in O2, p < 0.05). At exercise, BRS in φ1 was 6.4 [3.9–13.1] in air and 6.7 [4.1–9.5] in O2. After attainment of minimum MAP (MAPmin), baroreflex resetting started. After attainment of minimum RRi, baroreflex sequences reappeared. In φ2, BRS at rest was 12.1 [9.6–16.2] in air, 12.9 [9.2–15.8] in O2. At exercise (no φ2 in air), it was 7.9 [5.4–10.7] in O2. In φ2, OP acts at higher MAP values. Conclusion In apnoea φ1, there is a sudden correction of MAP fall via baroreflex. The lower BRS in the earliest φ1 suggests a possible parasympathetic mechanism underpinning this reduction. After MAPmin, baroreflex resets, displacing its OP at higher MAP level; thus, resetting may not be due to central command. After resetting, restoration of BRS suggests re-establishment of vagal drive.
Collapse
|
11
|
Chowdhury T, Sternberg Z, Golanov E, Gelpi R, Rosemann T, Schaller BJ. Photic sneeze reflex: another variant of the trigeminocardiac reflex? FUTURE NEUROLOGY 2019. [DOI: 10.2217/fnl-2019-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The photic sneeze reflex (PSR) is a condition of uncontrollable sneezing episodes in response to bright light. This reflex often manifests as a mild phenomenon but may cause devastating consequences in some situations (aeroplane pilots, car drivers, etc.). Its exact mechanism is poorly understood. Interestingly, the roles of the fifth and tenth cranial nerves, brainstem nuclei and inciting patterns closely mimic a well-known brainstem reflex, known as the trigeminocardiac reflex (TCR). In this critical review, we hypothesize that the PSR can be a variant of the TCR. This concept will lead to a better understanding of the PSR and sharpens the TCR characteristics and open the doors for new research possibilities.
Collapse
Affiliation(s)
- Tumul Chowdhury
- Department of Anaesthesiology & Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Zohara Sternberg
- Department of Neurology, Buffalo University of New York, NY, USA
| | - Eugene Golanov
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA & Weill Cornell Medicine, NY, USA
| | - Riccardo Gelpi
- Department of Cardiovascular Pathophysiology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Thomas Rosemann
- Department of Primary Care, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
12
|
Taboni A, Fagoni N, Moia C, Vinetti G, Ferretti G. Gas exchange and cardiovascular responses during breath-holding in divers. Respir Physiol Neurobiol 2019; 267:27-34. [PMID: 31201868 DOI: 10.1016/j.resp.2019.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022]
Abstract
To check whether the evolution of alveolar pressures of O2 (PAO2) and CO2 (PACO2) explains the cardiovascular responses to apnoea, eight divers performed resting apnoeas of increasing duration in air and in O2. We measured heart rate (fH), arterial pressure (AP), and peripheral resistances (TPR) beat-by-beat, PAO2 and PACO2 at the end of each apnoea. The three phases of the cardiovascular response to apnoea were observed. In O2, TPR increase (9 ± 4 mmHg min l-1) and fH decrease (-11 ± 8 bpm) were lower than in air (15 ± 5 mmHg min l-1 and -28 ± 13 bpm, respectively). At end of maximal apnoeas in air, PAO2 and PACO2 were 50 ± 9 and 48 ± 5 mmHg, respectively; corresponding values in O2 were 653 ± 8 mmHg and 55 ± 5 mmHg. At end of phase II, PAO2 and PACO2 in air were 90 ± 13 mmHg and 42 ± 4 mmHg respectively; corresponding values in O2 were 669 ± 7 mmHg and 47 ± 6 mmHg. The PACO2 increase may trigger the AP rise in phase III.
Collapse
Affiliation(s)
- Anna Taboni
- Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergencies, University of Geneva, rue Michel Servet 1, CH-1211, Geneva, Switzerland.
| | - Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Christian Moia
- Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergencies, University of Geneva, rue Michel Servet 1, CH-1211, Geneva, Switzerland; Department of Basic Neurosciences, University of Geneva, rue Michel Servet 1, CH-1211, Geneva, Switzerland
| | - Giovanni Vinetti
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Guido Ferretti
- Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergencies, University of Geneva, rue Michel Servet 1, CH-1211, Geneva, Switzerland; Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy; Department of Basic Neurosciences, University of Geneva, rue Michel Servet 1, CH-1211, Geneva, Switzerland
| |
Collapse
|
13
|
Eichhorn L, Doerner J, Luetkens JA, Lunkenheimer JM, Dolscheid-Pommerich RC, Erdfelder F, Fimmers R, Nadal J, Stoffel-Wagner B, Schild HH, Hoeft A, Zur B, Naehle CP. Cardiovascular magnetic resonance assessment of acute cardiovascular effects of voluntary apnoea in elite divers. J Cardiovasc Magn Reson 2018; 20:40. [PMID: 29909774 PMCID: PMC6004697 DOI: 10.1186/s12968-018-0455-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prolonged breath holding results in hypoxemia and hypercapnia. Compensatory mechanisms help maintain adequate oxygen supply to hypoxia sensitive organs, but burden the cardiovascular system. The aim was to investigate human compensatory mechanisms and their effects on the cardiovascular system with regard to cardiac function and morphology, blood flow redistribution, serum biomarkers of the adrenergic system and myocardial injury markers following prolonged apnoea. METHODS Seventeen elite apnoea divers performed maximal breath-hold during cardiovascular magnetic resonance imaging (CMR). Two breath-hold sessions were performed to assess (1) cardiac function, myocardial tissue properties and (2) blood flow. In between CMR sessions, a head MRI was performed for the assessment of signs of silent brain ischemia. Urine and blood samples were analysed prior to and up to 4 h after the first breath-hold. RESULTS Mean breath-hold time was 297 ± 52 s. Left ventricular (LV) end-systolic, end-diastolic, and stroke volume increased significantly (p < 0.05). Peripheral oxygen saturation, LV ejection fraction, LV fractional shortening, and heart rate decreased significantly (p < 0.05). Blood distribution was diverted to cerebral regions with no significant changes in the descending aorta. Catecholamine levels, high-sensitivity cardiac troponin, and NT-pro-BNP levels increased significantly, but did not reach pathological levels. CONCLUSION Compensatory effects of prolonged apnoea substantially burden the cardiovascular system. CMR tissue characterisation did not reveal acute myocardial injury, indicating that the resulting cardiovascular stress does not exceed compensatory physiological limits in healthy subjects. However, these compensatory mechanisms could overly tax those limits in subjects with pre-existing cardiac disease. For divers interested in competetive apnoea diving, a comprehensive medical exam with a special focus on the cardiovascular system may be warranted. TRIAL REGISTRATION This prospective single-centre study was approved by the institutional ethics committee review board. It was retrospectively registered under ClinicalTrials.gov (Trial registration: NCT02280226 . Registered 29 October 2014).
Collapse
Affiliation(s)
- L. Eichhorn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - J. Doerner
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - J. A. Luetkens
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | | | | | - F. Erdfelder
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - R. Fimmers
- Medical Biometry, Information Technology and Epidemiology, University of Bonn, Bonn, Germany
| | - J. Nadal
- Medical Biometry, Information Technology and Epidemiology, University of Bonn, Bonn, Germany
| | - B. Stoffel-Wagner
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Bonn, Germany
| | - H. H. Schild
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - A. Hoeft
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - B. Zur
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Bonn, Germany
| | - C. P. Naehle
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
14
|
Cardiovascular responses to dry apnoeas at exercise in air and in pure oxygen. Respir Physiol Neurobiol 2018; 255:17-21. [PMID: 29733980 DOI: 10.1016/j.resp.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/26/2018] [Accepted: 05/02/2018] [Indexed: 12/13/2022]
Abstract
If, as postulated, the end of the steady state phase (φ2) of cardiovascular responses to apnoea corresponds to the physiological breaking point, then we may hypothesize that φ2 should become visible if exercise apnoeas are performed in pure oxygen. We tested this hypothesis on 9 professional divers by means of continuous recording of blood pressure (BP), heart rate (fH), stroke volume (QS), and arterial oxygen saturation (SpO2) during dry maximal exercising apnoeas in ambient air and in oxygen. Apnoeas lasted 45.0 ± 16.9 s in air and 77.0 ± 28.9 s in oxygen (p < 0.05). In air, no φ2 was observed. Conversely, in oxygen, a φ2 of 28 ± 5 s duration appeared, during which systolic BP (185 ± 29 mmHg), fH (93 ± 16 bpm) and QS (91 ± 16 ml) remained stable. End-apnoea SpO2 was 95.5 ± 1.9% in air and 100% in oxygen. The results support the tested hypothesis.
Collapse
|
15
|
Eichhorn L, Dolscheid-Pommerich R, Erdfelder F, Ayub MA, Schmitz T, Werner N, Jansen F. Sustained apnea induces endothelial activation. Clin Cardiol 2017; 40:704-709. [PMID: 28464406 DOI: 10.1002/clc.22720] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Apnea diving has gained worldwide popularity, even though the pathophysiological consequences of this challenging sport on the human body are poorly investigated and understood. This study aims to assess the influence of sustained apnea in healthy volunteers on circulating microparticles (MPs) and microRNAs (miRs), which are established biomarkers reflecting vascular function. HYPOTHESIS Short intermittent hypoxia due to voluntary breath-holding affects circulating levels of endothelial cell-derived MPs (EMPs) and endothelial cell-derived miRs. METHODS Under dry laboratory conditions, 10 trained apneic divers performed maximal breath-hold. Venous blood samples were taken, once before and at 4 defined points in time after apnea. Samples were analyzed for circulating EMPs and endothelial miRs. RESULTS Average apnea time was 329 seconds (±103), and SpO2 at the end of apnea was 79% (±12). Apnea was associated with a time-dependent increase of circulating endothelial cell-derived EMPs and endothelial miRs. Levels of circulating EMPs in the bloodstream reached a peak 4 hours after the apnea period and returned to baseline levels after 24 hours. Circulating miR-126 levels were elevated at all time points after a single voluntary maximal apnea, whereas miR-26 levels were elevated significantly only after 30 minutes and 4 hours. Also miR-21 and miR-92 levels increased, but did not reach the level of significance. CONCLUSIONS Even a single maximal breath-hold induces acute endothelial activation and should be performed with great caution by subjects with preexisting vascular diseases. Voluntary apnea might be used as a model to simulate changes in endothelial function caused by hypoxia in humans.
Collapse
Affiliation(s)
- Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | | | - Felix Erdfelder
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | | | - Theresa Schmitz
- Department of Medicine II, Heart Center Bonn, University Hospital of Bonn, Bonn, Germany
| | - Nikos Werner
- Department of Medicine II, Heart Center Bonn, University Hospital of Bonn, Bonn, Germany
| | - Felix Jansen
- Department of Medicine II, Heart Center Bonn, University Hospital of Bonn, Bonn, Germany
| |
Collapse
|
16
|
Fagoni N, Taboni A, Vinetti G, Bottarelli S, Moia C, Bringard A, Ferretti G. Alveolar gas composition during maximal and interrupted apnoeas in ambient air and pure oxygen. Respir Physiol Neurobiol 2016; 235:45-51. [PMID: 27721037 DOI: 10.1016/j.resp.2016.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We tested the hypothesis that the alveolar gas composition at the transition between the steady phase II (φ2) and the dynamic phase III (φ3) of the cardiovascular response to apnoea may lay on the physiological breaking point curve (Lin et al., 1974). METHODS Twelve elite divers performed maximal and φ2-interrupted apnoeas, in air and pure oxygen. We recorded beat-by-beat arterial blood pressure and heart rate; we measured alveolar oxygen and carbon dioxide pressures (PAO2 and PACO2, respectively) before and after apnoeas; we calculated the PACO2 difference between the end and the beginning of apnoeas (ΔPACO2). RESULTS Cardiovascular responses to apnoea were similar compared to previous studies. PAO2 and PACO2 at the end of φ2-interrupted apnoeas, corresponded to those reported at the physiological breaking point. For maximal apnoeas, PACO2 was less than reported by Lin et al. (1974). ΔPACO2 was higher in oxygen than in air. CONCLUSIONS The transition between φ2 and φ3 corresponds indeed to the physiological breaking point. We attribute this transition to ΔPACO2, rather than the absolute PACO2 values, both in air and oxygen apnoeas.
Collapse
Affiliation(s)
- Nazzareno Fagoni
- Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy; Dipartimento di Specialità Medico-chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università di Brescia, Italy.
| | - Anna Taboni
- Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia, Italy
| | - Giovanni Vinetti
- Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia, Italy
| | - Sara Bottarelli
- Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy
| | - Christian Moia
- Département des Neurosciences Fondamentales, Université de Genève, Switzerland
| | - Aurélién Bringard
- Département des Neurosciences Fondamentales, Université de Genève, Switzerland
| | - Guido Ferretti
- Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy; Département des Neurosciences Fondamentales, Université de Genève, Switzerland
| |
Collapse
|