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Plunkett G, Yiallourou S, Voigt A, Segumohamed A, Shepherd K, Horne R, Wong F. Short apneas and periodic breathing in preterm infants in the neonatal intensive care unit-Effects of sleep position, sleep state, and age. J Sleep Res 2024:e14253. [PMID: 38837291 DOI: 10.1111/jsr.14253] [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: 01/18/2024] [Revised: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
This observational study investigated the effects of sleep position and sleep state on short apneas and periodic breathing in hospitalized preterm infants longitudinally, in relation to postmenstrual age. Preterm infants (25-31 weeks gestation, n = 29) were studied fortnightly after birth until discharge, in prone and supine positions, and in quiet sleep and active sleep. The percentage of time spent in each sleep state (percentage of time in quiet sleep and percentage of time in active sleep), percentage of total sleep time spent in short apneas and periodic breathing, respectively, the percentage of falls from baseline in heart rate, arterial oxygen saturation and cerebral tissue oxygenation index during short apneas and periodic breathing, and the associated percentage of total sleep time with systemic (arterial oxygen saturation < 90%) and cerebral hypoxia (cerebral tissue oxygenation index < 55%) were analysed using a linear mixed model. Results showed that the prone position decreased (improved) the percentage of falls from baseline in arterial oxygen saturation during both short apneas and periodic breathing, decreased the proportion of infants with periodic breathing and the periodic breathing-associated percentage of total sleep time with cerebral hypoxia. The percentage of time in quiet sleep was higher in the prone position. Quiet sleep decreased the percentage of total sleep time spent in short apneas, the short apneas-associated percentage of falls from baseline in heart rate, arterial oxygen saturation, and proportion of infants with systemic hypoxia. Quiet sleep also decreased the proportion of infants with periodic breathing and percentage of total sleep time with cerebral hypoxia. The effects of sleep position and sleep state were not related to postmenstrual age. In summary, when sleep state is controlled for, the prone sleeping position has some benefits during both short apneas and periodic breathing. Quiet sleep improves cardiorespiratory stability and is increased in the prone position at the expense of active sleep, which is critical for brain maturation. This evidence should be considered in positioning preterm infants.
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Affiliation(s)
- Georgina Plunkett
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Stephanie Yiallourou
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Aimee Voigt
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Aishah Segumohamed
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Kelsee Shepherd
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Rosemary Horne
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Flora Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
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Joshi SS, Sivapalan D, Leclerc MJ, Kapur N. Home continuous positive airway pressure therapy in infants: a single-center experience. J Clin Sleep Med 2023; 19:473-477. [PMID: 36458731 PMCID: PMC9978439 DOI: 10.5664/jcsm.10366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 12/04/2022]
Abstract
STUDY OBJECTIVES There are limited data on indications and outcomes of home continuous positive airway pressure (CPAP) therapy in the first year of life. We aimed to analyze the clinical, demographic, and polysomnographic characteristics of a cohort of children initiated on home CPAP for treatment of sleep-disordered breathing and as respiratory support in the first year of life. METHODS Children started on CPAP in the first year of life at the Queensland Children's Hospital were retrospectively evaluated for clinical and demographic parameters, underlying diagnoses, respiratory support, airway surgical intervention, and polysomnography results at baseline and on CPAP. RESULTS Twenty-nine infants (median age [interquartile range] at CPAP initiation, 182 days [126-265.5 days]) were included. The underlying etiology included Trisomy 21 (n = 6), craniofacial syndromes (n = 5), hypotonia (n = 8; 5 with noncraniofacial syndrome), airway malacia (n = 5), skeletal dysplasia (n = 2), nonsyndromic upper airway obstruction (n = 2), and chronic neonatal lung disease (n = 1). The median (interquartile range) obstructive apnea-hypopnea index was 14 events/h (6.2-31 events/h) at CPAP initiation, which improved on CPAP to 3.4 events/h (1.4-6.4 events/h). The median (interquartile range) transcutaneous CO2 max remained unchanged on CPAP (56.6 mm Hg [49-66.5 mm Hg] pre-CPAP vs 54.9 mm Hg [47-62 mm Hg] on CPAP). Fifteen children needed surgical airway intervention (11 pre-CPAP and 4 post-CPAP). CPAP therapy could be successfully stopped in 9 children, 2 children needed tracheostomy, and 1 child died during the follow-up period. CONCLUSIONS Home CPAP as respiratory support is an effective long-term therapy in infancy, and these patients can be weaned from CPAP therapy even if it was initiated early. Prospective studies with predefined criteria for CPAP initiation and cessation would help ascertain long-term outcomes in this poorly researched group. CITATION Joshi SS, Sivapalan D, Leclerc M-J, Kapur N. Home continuous positive airway pressure therapy in infants: a single-center experience. J Clin Sleep Med. 2023;19(3):473-477.
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Affiliation(s)
- Shambhavi Sahotra Joshi
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Dasheni Sivapalan
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Marie-Josee Leclerc
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of medicine, University of Queensland, South Brisbane, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, School of Medicine, University of Queensland, South Brisbane, Queensland, Australia
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Abstract
Human adult laughter is characterized by vocal bursts produced predominantly during exhalation, yet apes laugh while exhaling and inhaling. The current study investigated our hypothesis that laughter of human infants changes from laughter similar to that of apes to increasingly resemble that of human adults over early development. We further hypothesized that the more laughter is produced on the exhale, the more positively it is perceived. To test these predictions, novice (n = 102) and expert (phonetician, n = 15) listeners judged the extent to which human infant laughter (n = 44) was produced during inhalation or exhalation, and the extent to which they found the laughs pleasant and contagious. Support was found for both hypotheses, which were further confirmed in two pre-registered replication studies. Likely through social learning and the anatomical development of the vocal production system, infants' initial ape-like laughter transforms into laughter similar to that of adult humans over the course of ontogeny.
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Affiliation(s)
- Mariska E Kret
- Cognitive Psychology Unit, Leiden University, Leiden 2333 AK, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden 2333 AK, The Netherlands
| | - Dianne Venneker
- Cognitive Psychology Unit, Leiden University, Leiden 2333 AK, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden 2333 AK, The Netherlands
| | - Bronwen Evans
- Department of Speech, Hearing and Phonetic Sciences, University College London, Chandler House, 2 Wakefield Street, London WC1N 1PF, UK
| | - Iliana Samara
- Cognitive Psychology Unit, Leiden University, Leiden 2333 AK, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden 2333 AK, The Netherlands
| | - Disa Sauter
- Department of Social Psychology, University of Amsterdam, Amsterdam 1018 WS, The Netherlands
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Wheeler JA, Tutrow KD, Ebenroth ES, Gaston B, Bandyopadhyay A. Heart failure is not a determinant of central sleep apnea in the pediatric population. Pediatr Pulmonol 2021; 56:1092-1102. [PMID: 33434409 PMCID: PMC8035286 DOI: 10.1002/ppul.25242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/20/2020] [Accepted: 12/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Adults with heart failure (HF) have high prevalence of central sleep apnea (CSA). While this has been repeatedly investigated in adults, there is a deficiency of similar research in pediatric populations. The goal of this study was to compare prevalence of CSA in children with and without HF and correlate central apneic events with heart function. METHODS Retrospective analysis of data from children with and without HF was conducted. Eligible children were less than 18 years old with echocardiogram and polysomnogram within 6 months of each other. Children were separated into groups with and without HF based on left ventricular ejection fraction (LVEF). Defining CSA as central apnea-hypopnea index (CAHI) more than 1/hour, the cohort was also classified into children with and without CSA for comparative study. RESULTS A total of 120 children (+HF: 19, -HF: 101) were included. The +HF group was younger, with higher prevalence of trisomy 21, muscular dystrophy, oromotor incoordination, and structural heart disease. The +HF group had lower apnea-hypopnea index (median: 3/hour vs. 8.6/hour) and lower central apnea index (CAI) (median: 0.2/hour vs. 0.55/hour). Prevalence of CSA was similar in both groups (p = .195). LogCAHI was inversely correlated to age (Pearson correlation coefficient: -0.245, p = .022). Children with CSA were younger and had higher prevalence of prematurity (40% vs. 5.3%). There was no significant difference in LVEF between children with and without CSA. After excluding children with prematurity, relationship between CAHI and age was no longer sustained. CONCLUSIONS In contrast to adults, there is no difference in prevalence of CSA in children with and without HF. Unlike in adults, LVEF does not correlate with CAI in children. Overall, it appears that central apneic events may be more a function of age and prematurity rather than of heart function.
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Affiliation(s)
| | | | - Eric S. Ebenroth
- Indiana University School of Medicine, Division of Pediatric Cardiology
| | - Benjamin Gaston
- Indiana University School of Medicine, Section of Pediatric Pulmonology, Allergy and Sleep Medicine
| | - Anuja Bandyopadhyay
- Indiana University School of Medicine, Section of Pediatric Pulmonology, Allergy and Sleep Medicine
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Bandyopadhyay A, Daftary AS. Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know. Clin Pediatr (Phila) 2020; 59:752-759. [PMID: 32274936 DOI: 10.1177/0009922820915733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Porzionato A, Macchi V, De Caro R. Central and peripheral chemoreceptors in sudden infant death syndrome. J Physiol 2018; 596:3007-3019. [PMID: 29645275 PMCID: PMC6068209 DOI: 10.1113/jp274355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/20/2018] [Indexed: 11/08/2022] Open
Abstract
The pathogenesis of sudden infant death syndrome (SIDS) has been ascribed to an underlying biological vulnerability to stressors during a critical period of development. This paper reviews the main data in the literature supporting the role of central (e.g. retrotrapezoid nucleus, serotoninergic raphe nuclei, locus coeruleus, orexinergic neurons, ventral medullary surface, solitary tract nucleus) and peripheral (e.g. carotid body) chemoreceptors in the pathogenesis of SIDS. Clinical and experimental studies indicate that central and peripheral chemoreceptors undergo critical development during the initial postnatal period, consistent with the age range of SIDS (<1 year). Most of the risk factors for SIDS (gender, genetic factors, prematurity, hypoxic/hyperoxic stimuli, inflammation, perinatal exposure to cigarette smoke and/or substance abuse) may structurally and functionally affect the developmental plasticity of central and peripheral chemoreceptors, strongly suggesting the involvement of these structures in the pathogenesis of SIDS. Morphometric and neurochemical changes have been found in the carotid body and brainstem respiratory chemoreceptors of SIDS victims, together with functional signs of chemoreception impairment in some clinical studies. However, the methodological problems of SIDS research will have to be addressed in the future, requiring large and highly standardized case series. Up-to-date autopsy protocols should be produced, involving substantial, and exhaustive sampling of all potentially involved structures (including peripheral arterial chemoreceptors). Morphometric approaches should include unbiased stereological methods with three-dimensional probes. Prospective clinical studies addressing functional tests and risk factors (including genetic traits) would probably be the gold standard, allowing markers of intrinsic or acquired vulnerability to be properly identified.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of NeuroscienceUniversity of PadovaItaly
| | - Veronica Macchi
- Section of Anatomy, Department of NeuroscienceUniversity of PadovaItaly
| | - Raffaele De Caro
- Section of Anatomy, Department of NeuroscienceUniversity of PadovaItaly
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Rousseau JP, Tenorio-Lopes L, Baldy C, Janes TA, Fournier S, Kinkead R. On the origins of sex-based differences in respiratory disorders: Lessons and hypotheses from stress neuroendocrinology in developing rats. Respir Physiol Neurobiol 2017; 245:105-121. [DOI: 10.1016/j.resp.2017.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 12/31/2022]
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Sá RWM, Haibara AS, Gomes PM, Aguiar GL, Nascimento RSL, Pedrosa ML, Alzamora AC, de Oliveira LB, Cardoso LM. Changes in cardiovascular responses to chemoreflex activation of rats recovered from protein restriction are not related to AT 1 receptors. Exp Physiol 2017; 102:34-47. [PMID: 27763697 DOI: 10.1113/ep085791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/17/2016] [Indexed: 12/18/2022]
Abstract
NEW FINDINGS What is the central question of this study? In this study, we sought to investigate whether cardiovascular responses to peripheral chemoreflex activation of rats recovered from protein restriction are related to activation of AT1 receptors. What is the main finding and its importance? This study highlights the fact that angiotensinergic mechanisms activated by AT1 receptors do not support increased responses to peripheral chemoreflex activation by KCN in rats recovered from protein restriction. Also, we found that protein restriction led to increased resting ventilation in adult rats, even after recovery. The effects of a low-protein diet followed by recovery on cardiorespiratory responses to peripheral chemoreflex activation were tested before and after systemic angiotensin II type 1 (AT1 ) receptor antagonism. Male Fischer rats were divided into control and recovered (R-PR) groups after weaning. The R-PR rats were fed a low-protein (8%) diet for 35 days and recovered with a normal protein (20%) diet for 70 days. Control rats received a normal protein diet for 105 days (CG105 ). After cannulation surgery, mean arterial pressure, heart rate, respiratory frequency, tidal volume and minute ventilation were acquired using a digital recording system in freely moving rats. The role of angintensin II was evaluated by systemic antagonism of AT1 receptors with losartan (20 mg kg-1 i.v.). The peripheral chemoreflex was elicited by increasing doses of KCN (20-160 μg kg min-1 , i.v.). At baseline, R-PR rats presented increased heart rate and minute ventilation (372 ± 34 beats min-1 and 1.274 ± 377 ml kg-1 min-1 ) compared with CG105 animals (332 ± 22 beats min-1 and 856 ± 112 ml kg-1 min-1 ). Mean arterial pressure was not different between the groups. Pressor and bradycardic responses evoked by KCN (60 μg kg-1 ) were increased in R-PR (+45 ± 13 mmHg and -77 ± 47 beats min-1 ) compared with CG105 rats (+25 ± 17 mmHg and -27 ± 28 beats min-1 ), but no difference was found in the tachypnoeic response. These differences were preserved after losartan. The data suggest that angiotensin II acting on AT1 receptors may not be associated with the increased heart rate, increased minute ventilation and acute cardiovascular responses to peripheral chemoreflex activation in rats that underwent postweaning protein restriction followed by recovery.
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Affiliation(s)
- Renato Willian Martins Sá
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
| | - Andrea Siqueira Haibara
- Department of Physiology and Biophysics, ICB, Federal University of Minas Gerais, 31, 270-910, Belo Horizonte, MG, Brazil
| | - Paula Magalhães Gomes
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
| | - Giovana Lopes Aguiar
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
| | - Rafael Souza Leopoldino Nascimento
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
| | - Maria Lucia Pedrosa
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
| | - Andréia Carvalho Alzamora
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
| | - Lisandra Brandino de Oliveira
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
| | - Leonardo Máximo Cardoso
- Department of Biological Sciences, ICEB/NUPEB, Federal University of Ouro Preto - Campus Universitário Morro do Cruzeiro, 35, 400-000, Ouro Preto, MG, Brazil
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Gokozan HN, Baig F, Corcoran S, Catacutan FP, Gygli PE, Takakura AC, Moreira TS, Czeisler C, Otero JJ. Area postrema undergoes dynamic postnatal changes in mice and humans. J Comp Neurol 2015; 524:1259-69. [PMID: 26400711 DOI: 10.1002/cne.23903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 12/29/2022]
Abstract
The postnatal period in mammals represents a developmental epoch of significant change in the autonomic nervous system (ANS). This study focuses on postnatal development of the area postrema, a crucial ANS structure that regulates temperature, breathing, and satiety, among other activities. We find that the human area postrema undergoes significant developmental changes during postnatal development. To characterize these changes further, we used transgenic mouse reagents to delineate neuronal circuitry. We discovered that, although a well-formed ANS scaffold exists early in embryonic development, the area postrema shows a delayed maturation. Specifically, postnatal days 0-7 in mice show no significant change in area postrema volume or synaptic input from PHOX2B-derived neurons. In contrast, postnatal days 7-20 show a significant increase in volume and synaptic input from PHOX2B-derived neurons. We conclude that key ANS structures show unexpected dynamic developmental changes during postnatal development. These data provide a basis for understanding ANS dysfunction and disease predisposition in premature and postnatal humans.
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Affiliation(s)
- Hamza Numan Gokozan
- The Ohio State University, College of Medicine, Department of Pathology, Division of Neuropathology, Columbus, Ohio, 43210
| | - Faisal Baig
- The Ohio State University, College of Medicine, Department of Pathology, Division of Neuropathology, Columbus, Ohio, 43210
| | - Sarah Corcoran
- The Ohio State University, College of Medicine, Department of Pathology, Division of Neuropathology, Columbus, Ohio, 43210
| | - Fay Patsy Catacutan
- The Ohio State University, College of Medicine, Department of Pathology, Division of Neuropathology, Columbus, Ohio, 43210
| | - Patrick Edwin Gygli
- The Ohio State University, College of Medicine, Department of Pathology, Division of Neuropathology, Columbus, Ohio, 43210
| | - Ana C Takakura
- Department of Pharmacology, Institute of Biomedical Science, University of São Paulo, 05508-900, São Paulo, Brazil
| | - Thiago S Moreira
- Department of Physiology and Biophysics, Institute of Biomedical Science, University of São Paulo, 05508-900, São Paulo, Brazil
| | - Catherine Czeisler
- The Ohio State University, College of Medicine, Department of Pathology, Division of Neuropathology, Columbus, Ohio, 43210
| | - José J Otero
- The Ohio State University, College of Medicine, Department of Pathology, Division of Neuropathology, Columbus, Ohio, 43210
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Lee JJ, Thottam PJ, Ford MD, Jabbour N. Characteristics of sleep apnea in infants with Pierre-Robin sequence: Is there improvement with advancing age? Int J Pediatr Otorhinolaryngol 2015; 79:2059-67. [PMID: 26429600 DOI: 10.1016/j.ijporl.2015.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/09/2015] [Accepted: 09/13/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate changes in obstructive sleep apnea (OSA) and central sleep apnea (CSA) in infants with Pierre-Robin sequence (PRS) with advancing age and after mandibular distraction osteogenesis (MDO). METHODS Charts from 141 infants with PRS that presented to our tertiary-care children's hospital between 2005 and 2015 were retrospectively reviewed. Forty-five patients received a polysomnogram (PSG) prior to surgical intervention. Linear regression was utilized to compare age at pre-operative PSG with apnea-hypopnea index (AHI), obstructive apnea-hypopnea index (OAHI), and central apnea index (CAI). We then analyzed a subset of 9 patients who underwent MDO with pre- and post-operative PSGs. Wilcoxon signed-rank test was utilized to examine differences in pre- and post-operative OSA and CSA scores. RESULTS Forty-five patients received pre-operative PSGs. Of these, 80.0% demonstrated severe sleep apnea (AHI≥10), 68.9% demonstrated severe obstructive sleep apnea (OAHI≥10), and 55.6% demonstrated central sleep apnea (CAI≥1). There was no significant pattern of decrease in AHI, OAHI, and CAI with increased age up to 1 year. Among the 9 patients who underwent MDO with pre- and post-operative PSGs, significant reductions in AHI, OAHI, CAI, and percentage of total sleep time with arterial oxygen saturation (SaO2) <90% and significant increases in SaO2 nadir were identified after MDO. CONCLUSIONS Contrary to previously examined literature in non-PRS patients, we did not find a decreased severity of central or obstructive sleep apnea with advancing age. Infants with PRS who underwent MDO demonstrated significant decreases in both obstructive and central apnea indices.
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Affiliation(s)
- Jake J Lee
- University of Pittsburgh School of Medicine, Department of Otolaryngology, 3550 Terrace St, Pittsburgh, PA 15261, United States
| | - Prasad J Thottam
- Department of Otolaryngology, Children's Hospital of Michigan, 3901 Beaubien St, Detroit, MI 48201, United States; Michigan Pediatric Ear, Nose & Throat Associates, 3901 Beaubien St, Detroit, MI 48201, United States
| | - Matthew D Ford
- Cleft-Craniofacial Center, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA, United States
| | - Noel Jabbour
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
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Ballot O, Laouafa S, Elliot-Portal E, Tam R, Voituron N, Joseph V, Soliz J. The central chemosensitivity is not altered by cerebral erythropoietin. Neurosci Lett 2015; 609:63-8. [PMID: 26472708 DOI: 10.1016/j.neulet.2015.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/23/2015] [Accepted: 10/08/2015] [Indexed: 11/26/2022]
Abstract
The stimulation of central chemoreceptors by CO2 is considered essential for breathing. The supporting evidence include the fact that central apnea in neonates correlates with immaturity of the CO2-sensing mechanism, and that congenital central hypoventilation syndrome (CCHS) is characterized by the absence of a ventilatory response to elevated PCO2. We reported previously that cerebral erythropoietin (Epo) is a potent respiratory stimulant upon normoxia and hypoxia. The injection of soluble Epo receptor (sEpoR; the natural EpoR competitor to bind Epo) via the cisterna magna (ICI: intra-cisternal injection) decreases basal ventilation in adult and newborn mice. Moreover, sEpoR induces respiratory depression in adult and newborn mice exposed to hypoxia. In this study we tested the hypothesis that endogenous brain Epo also modulates the respiratory stimulation induced by the activation of central CO2 chemoreceptors. Adult and newborn male and female mice received an injection of sEpoR or vehicle via the cisterna magna. Twenty-four hours later basal minute ventilation and the ventilatory response to hypercapnia (5% CO2) were evaluated by plethysmography. Our results did not show a difference in the hypercapnic response between sEpoR and vehicle-injected male or female mice at postnatal or adult ages. We concluded that endogenous brain Epo does not contribute to modulating the PCO2-mediated central activation of breathing.
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Affiliation(s)
- Orlane Ballot
- Centre de Recherche du CHU de Québec, Pavillon St François d'Assise, Département de Pédiatrie, Faculté de Médecine, Université Laval, QC, Canada
| | - Sofien Laouafa
- Centre de Recherche du CHU de Québec, Pavillon St François d'Assise, Département de Pédiatrie, Faculté de Médecine, Université Laval, QC, Canada
| | - Elizabeth Elliot-Portal
- Centre de Recherche du CHU de Québec, Pavillon St François d'Assise, Département de Pédiatrie, Faculté de Médecine, Université Laval, QC, Canada; Molecular biology and Biotechnology Institute, Universidad Mayor de San Andres, La Paz, Bolivia
| | - Rose Tam
- Centre de Recherche du CHU de Québec, Pavillon St François d'Assise, Département de Pédiatrie, Faculté de Médecine, Université Laval, QC, Canada
| | - Nicolas Voituron
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, Laboratoire "Hypoxie et poumons", EA 2363, 93017, Bobigny, France
| | - Vincent Joseph
- Centre de Recherche du CHU de Québec, Pavillon St François d'Assise, Département de Pédiatrie, Faculté de Médecine, Université Laval, QC, Canada
| | - Jorge Soliz
- Centre de Recherche du CHU de Québec, Pavillon St François d'Assise, Département de Pédiatrie, Faculté de Médecine, Université Laval, QC, Canada.
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12
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Yiallourou SR, Wallace EM, Miller SL, Horne RSC. Effects of intrauterine growth restriction on sleep and the cardiovascular system: The use of melatonin as a potential therapy? Sleep Med Rev 2015; 26:64-73. [PMID: 26140865 DOI: 10.1016/j.smrv.2015.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 12/28/2022]
Abstract
Intrauterine growth restriction (IUGR) complicates 5-10% of pregnancies and is associated with increased risk of preterm birth, mortality and neurodevelopmental delay. The development of sleep and cardiovascular control are closely coupled and IUGR is known to alter this development. In the long-term, IUGR is associated with altered sleep and an increased risk of hypertension in adulthood. Melatonin plays an important role in the sleep-wake cycle. Experimental animal studies have shown that melatonin therapy has neuroprotective and cardioprotective effects in the IUGR fetus. Consequently, clinical trials are currently underway to assess the short and long term effects of antenatal melatonin therapy in IUGR pregnancies. Given melatonin's role in sleep regulation, this hormone could affect the developing infants' sleep-wake cycle and cardiovascular function after birth. In this review, we will 1) examine the role of melatonin as a therapy for IUGR pregnancies and the potential implications on sleep and the cardiovascular system; 2) examine the development of sleep-wake cycle in fetal and neonatal life; 3) discuss the development of cardiovascular control during sleep; 4) discuss the effect of IUGR on sleep and the cardiovascular system and 5) discuss the future implications of melatonin therapy in IUGR pregnancies.
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Affiliation(s)
- Stephanie R Yiallourou
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Euan M Wallace
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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Ruffault PL, D'Autréaux F, Hayes JA, Nomaksteinsky M, Autran S, Fujiyama T, Hoshino M, Hägglund M, Kiehn O, Brunet JF, Fortin G, Goridis C. The retrotrapezoid nucleus neurons expressing Atoh1 and Phox2b are essential for the respiratory response to CO₂. eLife 2015; 4. [PMID: 25866925 PMCID: PMC4429526 DOI: 10.7554/elife.07051] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/09/2015] [Indexed: 01/08/2023] Open
Abstract
Maintaining constant CO2 and H+ concentrations in the arterial blood is critical for life. The principal mechanism through which this is achieved in mammals is the respiratory chemoreflex whose circuitry is still elusive. A candidate element of this circuitry is the retrotrapezoid nucleus (RTN), a collection of neurons at the ventral medullary surface that are activated by increased CO2 or low pH and project to the respiratory rhythm generator. Here, we use intersectional genetic strategies to lesion the RTN neurons defined by Atoh1 and Phox2b expression and to block or activate their synaptic output. Photostimulation of these neurons entrains the respiratory rhythm. Conversely, abrogating expression of Atoh1 or Phox2b or glutamatergic transmission in these cells curtails the phrenic nerve response to low pH in embryonic preparations and abolishes the respiratory chemoreflex in behaving animals. Thus, the RTN neurons expressing Atoh1 and Phox2b are a necessary component of the chemoreflex circuitry. DOI:http://dx.doi.org/10.7554/eLife.07051.001 An adult at rest will typically breathe in and out up to 20 times per minute, inhaling oxygen and exhaling carbon dioxide in a process that, for the most part, occurs automatically. While we can choose to override this process and exert voluntary control over our breathing, we cannot suppress it indefinitely. Attempting to do so will ultimately trigger a reflex that forces us to start breathing again. This reflex is mostly a response to the rise of carbon dioxide (CO2) in the blood, which lowers the pH of the blood. This rise in CO2 is toxic and triggers an increase in breathing so that the excess CO2 is exhaled. The majority of the sensors that detect CO2 are in the brainstem, which is at the junction of the brain and the spinal cord. However, the precise location of these sensors is not clear. Ruffault et al. now argue that the sensors are in a region called the ‘retrotrapezoid nucleus’, and that they can be identified by the presence of two proteins, Atoh1 and Phox2b. In the brains of foetal mice, Ruffault et al. recorded cells in the retrotrapezoid nucleus and found that they fired in a rhythmic pattern, as would be expected for cells that control breathing. Moreover, the firing rate of these cells increased when the pH was lowered. Ruffault et al. then created genetically modified mice with mutations in genes for Atoh1 or Phox2b. The retrotrapezoid nucleus was either absent or abnormal in these mutant mice. Moreover, new-born pups with these mutations were not able to increase their breathing when the level of CO2 in their blood rose. These results shed light on the respiratory distress experienced by patients with a rare disorder called congenital central hypoventilation syndrome (CCHS) that is caused by mutations in Phox2b. More commonly, unstable or irregular breathing is seen in human infants that are born prematurely, and sometimes in infants born at full term. In the light of the new findings by Ruffault et al., it is possible that abnormal development or immaturity of the retrotrapezoid nucleus is the cause. DOI:http://dx.doi.org/10.7554/eLife.07051.002
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Affiliation(s)
- Pierre-Louis Ruffault
- Université Paris-Saclay, Université Paris-Sud, CNRS, UMR 9197, Institut des Neurosciences Paris-Saclay, Gif-sur-Yvette, France
| | - Fabien D'Autréaux
- Institut de Biologie de l'École Normale Supérieure, Inserm U1024, and CNRS UMR 8197, Paris, France
| | - John A Hayes
- Université Paris-Saclay, Université Paris-Sud, CNRS, UMR 9197, Institut des Neurosciences Paris-Saclay, Gif-sur-Yvette, France
| | - Marc Nomaksteinsky
- Institut de Biologie de l'École Normale Supérieure, Inserm U1024, and CNRS UMR 8197, Paris, France
| | - Sandra Autran
- Université Paris-Saclay, Université Paris-Sud, CNRS, UMR 9197, Institut des Neurosciences Paris-Saclay, Gif-sur-Yvette, France
| | - Tomoyuki Fujiyama
- Department of Biochemistry and Cellular Biology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mikio Hoshino
- Department of Biochemistry and Cellular Biology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Martin Hägglund
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ole Kiehn
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jean-François Brunet
- Institut de Biologie de l'École Normale Supérieure, Inserm U1024, and CNRS UMR 8197, Paris, France
| | - Gilles Fortin
- Université Paris-Saclay, Université Paris-Sud, CNRS, UMR 9197, Institut des Neurosciences Paris-Saclay, Gif-sur-Yvette, France
| | - Christo Goridis
- Institut de Biologie de l'École Normale Supérieure, Inserm U1024, and CNRS UMR 8197, Paris, France
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14
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Decima PFF, Fyfe KL, Odoi A, Wong FY, Horne RSC. The longitudinal effects of persistent periodic breathing on cerebral oxygenation in preterm infants. Sleep Med 2015; 16:729-35. [PMID: 25959095 DOI: 10.1016/j.sleep.2015.02.537] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/14/2015] [Accepted: 02/13/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Periodic breathing is common in preterm infants, but is thought to be benign. The aim of our study was to assess the incidence and impact of periodic breathing on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI) over the first six months after term-equivalent age. STUDY DESIGN Twenty-four preterm infants (27-36 weeks gestational age) were studied with daytime polysomnography in quiet sleep (QS) and active sleep (AS) and in both the prone and supine positions at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age. HR, SpO2, and TOI (NIRO-200 spectrophotometer) were recorded. Periodic breathing episodes were defined as greater than or equal to three sequential apneas each lasting ≥3 s. RESULTS A total 164 individual episodes of periodic breathing were recorded in 19 infants at 2-4 weeks, 62 in 12 infants at 2-3 months, and 35 in 10 infants at 5-6 months. There was no effect of gestational age on periodic breathing frequency or duration. Falls in HR (-21.9 ± 2.7%) and TOI (-13.1 ± 1.5%) were significantly greater at 2-3 months of age compared to 2-4 weeks of age. CONCLUSIONS The majority of preterm infants discharged home without clinical respiratory problems had persistent periodic breathing. Although in most infants periodic breathing was not associated with significant falls in SpO2 or TOI, several infants had significant desaturations and reduced cerebral oxygenation especially during AS. The clinical significance of this on neurodevelopmental outcome is unknown and warrants further investigations.
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MESH Headings
- Brain/physiopathology
- Cross-Sectional Studies
- Female
- Follow-Up Studies
- Gestational Age
- Heart Rate/physiology
- Humans
- Hypoxia, Brain/diagnosis
- Hypoxia, Brain/epidemiology
- Hypoxia, Brain/physiopathology
- Infant
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/physiopathology
- Longitudinal Studies
- Male
- Oxygen/blood
- Oxygen Consumption/physiology
- Polysomnography
- Sleep Apnea, Central/diagnosis
- Sleep Apnea, Central/epidemiology
- Sleep Apnea, Central/physiopathology
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Affiliation(s)
- Pauline F F Decima
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia; Laboratoire PériTox, UMR-I 01 INERIS, Faculté de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Karinna L Fyfe
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia
| | - Flora Y Wong
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
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15
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Bates ML, Pillers DAM, Palta M, Farrell ET, Eldridge MW. Ventilatory control in infants, children, and adults with bronchopulmonary dysplasia. Respir Physiol Neurobiol 2013; 189:329-37. [PMID: 23886637 DOI: 10.1016/j.resp.2013.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 12/17/2022]
Abstract
Bronchopulmonary dysplasia (BPD), or chronic lung disease of prematurity, occurs in ~30% of preterm infants (15,000 per year) and is associated with a clinical history of mechanical ventilation and/or high inspired oxygen at birth. Here, we describe changes in ventilatory control that exist in patients with BPD, including alterations in chemoreceptor function, respiratory muscle function, and suprapontine control. Because dysfunction in ventilatory control frequently revealed when O2 supply and CO2 elimination are challenged, we provide this information in the context of four important metabolic stressors: stresses: exercise, sleep, hypoxia, and lung disease, with a primary focus on studies of human infants, children, and adults. As a secondary goal, we also identify three key areas of future research and describe the benefits and challenges of longitudinal human studies using well-defined patient cohorts.
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Affiliation(s)
- Melissa L Bates
- Department of Pediatrics, Division of Critical Care, University of Wisconsin, Madison, WI, USA; John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin, Madison, WI, USA.
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16
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Strey KA, Baertsch NA, Baker-Herman TL. Inactivity-induced respiratory plasticity: protecting the drive to breathe in disorders that reduce respiratory neural activity. Respir Physiol Neurobiol 2013; 189:384-94. [PMID: 23816599 DOI: 10.1016/j.resp.2013.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/04/2013] [Accepted: 06/24/2013] [Indexed: 12/25/2022]
Abstract
Multiple forms of plasticity are activated following reduced respiratory neural activity. For example, in ventilated rats, a central neural apnea elicits a rebound increase in phrenic and hypoglossal burst amplitude upon resumption of respiratory neural activity, forms of plasticity called inactivity-induced phrenic and hypoglossal motor facilitation (iPMF and iHMF), respectively. Here, we provide a conceptual framework for plasticity following reduced respiratory neural activity to guide future investigations. We review mechanisms giving rise to iPMF and iHMF, present new data suggesting that inactivity-induced plasticity is observed in inspiratory intercostals (iIMF) and point out gaps in our knowledge. We then survey conditions relevant to human health characterized by reduced respiratory neural activity and discuss evidence that inactivity-induced plasticity is elicited during these conditions. Understanding the physiological impact and circumstances in which inactivity-induced respiratory plasticity is elicited may yield novel insights into the treatment of disorders characterized by reductions in respiratory neural activity.
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Affiliation(s)
- K A Strey
- Department of Comparative Biosciences, University of Wisconsin, Madison, WI 53706, USA.
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17
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Gestational stress promotes pathological apneas and sex-specific disruption of respiratory control development in newborn rat. J Neurosci 2013; 33:563-73. [PMID: 23303936 DOI: 10.1523/jneurosci.1214-12.2013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Recurrent apneas are important causes of hospitalization and morbidity in newborns. Gestational stress (GS) compromises fetal brain development. Maternal stress and anxiety during gestation are linked to respiratory disorders in newborns; however, the mechanisms remain unknown. Here, we tested the hypothesis that repeated activation of the neuroendocrine response to stress during gestation is sufficient to disrupt the development of respiratory control and augment the occurrence of apneas in newborn rats. Pregnant dams were displaced and exposed to predator odor from days 9 to 19 of gestation. Control dams were undisturbed. Experiments were performed on male and female rats aged between 0 and 4 d old. Apnea frequency decreased with age but was consistently higher in stressed pups than controls. At day 4, GS augmented the proportion of apneas with O(2) desaturations by 12%. During acute hypoxia (12% O(2)), the reflexive increase in breathing augmented with age; however, this response was lower in stressed pups. Instability of respiratory rhythm recorded from medullary preparations decreased with age but was higher in stressed pups than controls. GS reduced medullary serotonin (5-HT) levels in newborn pups by 32%. Bath application of 5-HT and injection of 8-OH-DPAT [(±)-8-hydroxy-2-di-(n-propylamino) tetralin hydrobromide; 5-HT(1A) agonist; in vivo] reduced respiratory instability and apneas; these effects were greater in stressed pups than controls. Sex-specific effects were observed. We conclude that activation of the stress response during gestation is sufficient to disrupt respiratory control development and promote pathological apneas in newborn rats. A deficit in medullary 5-HT contributes to these effects.
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18
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Katz ES, Mitchell RB, D'Ambrosio CM. Obstructive sleep apnea in infants. Am J Respir Crit Care Med 2011; 185:805-16. [PMID: 22135346 DOI: 10.1164/rccm.201108-1455ci] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities; including a superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability. Congenital abnormalities of the airway, such as laryngomalacia, hemangiomas, pyriform aperture stenosis, choanal atresia, and laryngeal webs, may also have adverse effects on airway patency. Additional exacerbating factors predisposing infants toward airway collapse include neck flexion, airway secretions, gastroesophageal reflux, and sleep deprivation. Obstructive sleep apnea in infants has been associated with failure to thrive, behavioral deficits, and sudden infant death. The proper interpretation of infant polysomnography requires an understanding of normative data related to gestation and postconceptual age for apnea, arousal, and oxygenation. Direct visualization of the upper airway is an important diagnostic modality in infants with obstructive apnea. Treatment options for infant obstructive sleep apnea are predicated on the underlying etiology, including supraglottoplasty for severe laryngomalacia, mandibular distraction for micrognathia, tonsillectomy and/or adenoidectomy, choanal atresia repair, and/or treatment of gastroesophageal reflux.
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Affiliation(s)
- Eliot S Katz
- Division of Respiratory Diseases, Department of Medicine, Children's Hospital, Boston, MA, USA.
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19
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Abstract
Breathing is a spontaneous, rhythmic motor behavior critical for maintaining O(2), CO(2), and pH homeostasis. In mammals, it is generated by a neuronal network in the lower brainstem, the respiratory rhythm generator (Feldman et al., 2003). A century-old tenet in respiratory physiology posits that the respiratory chemoreflex, the stimulation of breathing by an increase in partial pressure of CO(2) in the blood, is indispensable for rhythmic breathing. Here we have revisited this postulate with the help of mouse genetics. We have engineered a conditional mouse mutant in which the toxic PHOX2B(27Ala) mutation that causes congenital central hypoventilation syndrome in man is targeted to the retrotrapezoid nucleus, a site essential for central chemosensitivity. The mutants lack a retrotrapezoid nucleus and their breathing is not stimulated by elevated CO(2) at least up to postnatal day 9 and they barely respond as juveniles, but nevertheless survive, breathe normally beyond the first days after birth, and maintain blood PCO(2) within the normal range. Input from peripheral chemoreceptors that sense PO(2) in the blood appears to compensate for the missing CO(2) response since silencing them by high O(2) abolishes rhythmic breathing. CO(2) chemosensitivity partially recovered in adulthood. Hence, during the early life of rodents, the excitatory input normally afforded by elevated CO(2) is dispensable for life-sustaining breathing and maintaining CO(2) homeostasis in the blood.
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20
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Gulemetova R, Kinkead R. Neonatal stress increases respiratory instability in rat pups. Respir Physiol Neurobiol 2011; 176:103-9. [DOI: 10.1016/j.resp.2011.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 11/25/2022]
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21
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Dwinell M, Hogan G, Sirlin E, Mayhew D, Forster H. Postnatal ventilatory response to CO2 in awake piglets. Respir Physiol Neurobiol 2011; 175:49-54. [DOI: 10.1016/j.resp.2010.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 08/13/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
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22
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Goridis C, Dubreuil V, Thoby-Brisson M, Fortin G, Brunet JF. Phox2b, congenital central hypoventilation syndrome and the control of respiration. Semin Cell Dev Biol 2010; 21:814-22. [DOI: 10.1016/j.semcdb.2010.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 07/25/2010] [Indexed: 10/19/2022]
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23
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Gallego J, Dauger S. PHOX2B mutations and ventilatory control. Respir Physiol Neurobiol 2009; 164:49-54. [PMID: 18675942 DOI: 10.1016/j.resp.2008.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 07/07/2008] [Accepted: 07/09/2008] [Indexed: 01/08/2023]
Abstract
The transcription factor PHOX2B is essential for the development of the autonomic nervous system. In humans, polyalanine expansion mutations in PHOX2B cause Congenital Central Hypoventilation Syndrome (CCHS), a rare life-threatening disorder characterized by hypoventilation during sleep and impaired chemosensitivity. CCHS is combined with comparatively less severe impairments of autonomic functions including thermoregulation, cardiac rhythm, and digestive motility. Respiratory phenotype analyses of mice carrying an invalidated Phox2b allele (Phox2b+/- mutant mice) or the Phox2b mutation (+7 alanine expansion) found in patients with CCHS (Phox2b(27Ala/+) mice) have shed light on the role for PHOX2B in breathing control and on the pathophysiological mechanisms underlying CCHS. Newborn mice that lacked one Phox2b allele (Phox2b+/-) had sleep apneas and depressed sensitivity to hypercapnia. However, these impairments resolved rapidly, whereas the CCHS phenotype is irreversible. Heterozygous Phox2b(27Ala/+) pups exhibited a lack of responsiveness to hypercapnia and unstable breathing; they died within the first few postnatal hours. The generation of mouse models of CCHS provides tools for evaluating treatments aimed at alleviating both the respiratory symptoms and all other autonomic symptoms of CCHS.
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Affiliation(s)
- Jorge Gallego
- INSERM, U676, Hôpital Robert Debré, 48 Bd Sérurier, 75019 Paris, France.
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24
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Risk factors for extreme events in infants hospitalized for apparent life-threatening events. J Pediatr 2009; 154:332-7, 337.e1-2. [PMID: 18950797 DOI: 10.1016/j.jpeds.2008.08.051] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 07/23/2008] [Accepted: 08/28/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether known risk factors for cardiorespiratory illnesses will help identify infants who could experience extreme events during an admission for an apparent life-threatening event (ALTE) or later at home. STUDY DESIGN Retrospective cohort study of all patients admitted for ALTE between 1996 and 2006. Extreme events included central apnea >30 seconds, bradycardia >10 seconds, and desaturation >10 seconds at hemoglobin-oxygen saturation value with pulse oximetry <80%. RESULTS Of the 625 patients included in the study, 46 (7.4%) had extreme cardiorespiratory events recorded, usually within 24 hours of hospital admission. The most frequent diagnosis was upper respiratory tract infection (URTI, 30 infants). These factors increased the likelihood of having extreme events (P < .0001): post-conceptional age <43 weeks (5.2-fold increase), premature birth (6.3-fold), and URTI symptoms (11.2-fold). The most frequent events were extreme desaturations (43/46 infants), preceded by a central apnea. Seven infants had extreme events recorded later during home monitoring (4 with URTI); all 7 infants had sustained extreme events in the hospital. CONCLUSION Extreme events were identified mostly in association with symptoms of URTIs, in infants born prematurely, and in infants <43 weeks post-conceptional age. Monitoring with a pulse oximeter should identify infants who sustain these events.
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25
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Dauger S, Ramanantsoa N. [Abnormal control of breathing in pediatrics]. Arch Pediatr 2008; 15:617-9. [PMID: 18582691 DOI: 10.1016/s0929-693x(08)71852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- S Dauger
- Service de Réanimation et Surveillance Continue Pédiatriques, Pôle de Pédiatrie Aiguë et Médecine Interne, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris, France.
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26
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Kang BJ, Chang DA, Mackay DD, West GH, Moreira TS, Takakura AC, Gwilt JM, Guyenet PG, Stornetta RL. Central nervous system distribution of the transcription factor Phox2b in the adult rat. J Comp Neurol 2007; 503:627-41. [PMID: 17559094 DOI: 10.1002/cne.21409] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Phox2b is required for development of the peripheral autonomic nervous system and a subset of cranial nerves and lower brainstem nuclei. Phox2b mutations in man cause diffuse autonomic dysfunction and deficits in the automatic control of breathing. Here we study the distribution of Phox2b in the adult rat hindbrain to determine whether this protein is selectively expressed by neurons involved in respiratory and autonomic control. In the medulla oblongata, Phox2b-immunoreactive nuclei were present in the dorsal vagal complex, intermediate reticular nucleus, dorsomedial spinal trigeminal nucleus, nucleus ambiguus, catecholaminergic neurons, and retrotrapezoid nucleus (RTN). Phox2b was expressed by both central excitatory relays of the sympathetic baroreflex (nucleus of the solitary tract and C1 neurons) but not by the inhibitory relay of this reflex. Phox2b was absent from the ventral respiratory column (VRC) caudal to RTN and rare within the parabrachial nuclei. In the pons, Phox2b was confined to cholinergic efferent neurons (salivary, vestibulocochlear) and noncholinergic peritrigeminal neurons. Rostral to the pons, Phox2b was detected only in the oculomotor complex. In adult rats, Phox2b is neither a comprehensive nor a selective marker of hindbrain autonomic pathways. This marker identifies a subset of hindbrain neurons that control orofacial movements (dorsomedial spinal trigeminal nucleus, pontine peritrigeminal neurons), balance and auditory function (vestibulocochlear efferents), the eyes, and both divisions of the autonomic efferent system. Phox2b is virtually absent from the respiratory rhythm and pattern generator (VRC and dorsolateral pons) but is highly expressed by neurons involved in the chemical drive and reflex regulation of this oscillator.
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Affiliation(s)
- B J Kang
- Department of Anesthesiology, Dankook University College of Medicine, Chonan City, 330-714 Republic of Korea
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27
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Brutsaert TD. Population genetic aspects and phenotypic plasticity of ventilatory responses in high altitude natives. Respir Physiol Neurobiol 2007; 158:151-60. [PMID: 17400521 DOI: 10.1016/j.resp.2007.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 02/26/2007] [Accepted: 03/03/2007] [Indexed: 11/21/2022]
Abstract
Highland natives show unique breathing patterns and ventilatory responses at altitude, both at rest and during exercise. For many ventilatory traits, there is also significant variation between highland native groups, including indigenous populations in the Andes and Himalaya, and more recent altitude arrivals in places like Colorado. This review summarizes the literature in this area with some focus on partitioning putative population genetic differences from differences acquired through lifelong exposure to hypoxia. Current studies suggest that Tibetans have high resting ventilation (V (E)), and a high hypoxic ventilatory response (HVR), similar to altitude acclimatized lowlanders. Andeans, in contrast, show low resting V (E) and a low or "blunted" HVR, with little evidence that these traits are acquired via lifelong exposure. Resting V (E) of non-indigenous altitude natives is not well documented, but lifelong hypoxic exposure almost certainly blunts HVR in these groups through decreased chemosensitivity to hypoxia in a process known as hypoxic desensitization (HD). Together, these studies suggest that the time course of ventilatory response, and in particular the origin or absence of HD, depends on population genetic background i.e., the allele or haplotype frequencies that characterize a particular population. During exercise, altitude natives have lower V (E) compared to acclimatized lowland controls. Altitude natives also have smaller alveolar-arterial partial pressure differences P(AO2) - P(aO2) during exercise suggesting differences in gas exchange efficiency. Small P(AO2) - P(aO2) in highland natives of Colorado underscores the likely importance of developmental adaptation to hypoxia affecting structural/functional aspects of gas exchange with resultant changes in breathing pattern. However, in Andeans, at least, there is also evidence that low exercise V (E) is determined by genetic background affecting ventilatory control independent of gas exchange. Additional studies are needed to elucidate the effects of gene, environment, and gene-environment interaction on these traits, and these effects are likely to differ widely between altitude native populations.
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Affiliation(s)
- Tom D Brutsaert
- Department of Anthropology, 1400 Washington Ave., The University at Albany, SUNY, Albany, NY 12222, United States.
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Rosin DL, Chang DA, Guyenet PG. Afferent and efferent connections of the rat retrotrapezoid nucleus. J Comp Neurol 2006; 499:64-89. [PMID: 16958085 DOI: 10.1002/cne.21105] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The rat retrotrapezoid nucleus (RTN) contains candidate central chemoreceptors that have extensive dendrites within the marginal layer (ML). This study describes the axonal projections of RTN neurons and their probable synaptic inputs. The ML showed a dense plexus of nerve terminals immunoreactive (ir) for markers of glutamatergic (vesicular glutamate transporters VGLUT1-3), gamma-aminobutyric acid (GABA)-ergic, adrenergic, serotonergic, cholinergic, and peptidergic transmission. The density of VGLUT3-ir terminals tracked the location of RTN chemoreceptors. The efferent and afferent projections of RTN were studied by placing small iontophoretic injections of anterograde (biotinylated dextran amine; BDA) and retrograde (cholera toxin B) tracers where RTN chemoreceptors have been previously recorded. BDA did not label the nearby C1 cells. BDA-ir varicosities were found in the solitary tract nucleus (NTS), all ventral respiratory column (VRC) subdivisions, A5 noradrenergic area, parabrachial complex, and spinal cord. In each target region, a large percentage of the BDA-ir varicosities was VGLUT2-ir (41-83%). Putative afferent input to RTN originated from spinal cord, caudal NTS, area postrema, VRC, dorsolateral pons, raphe nuclei, lateral hypothalamus, central amygdala, and insular cortex. The results suggest that 1) whether or not the ML is specialized for CO(2) sensing, its complex neuropil likely regulates the activity of RTN chemosensitive neurons; 2) the catecholaminergic, cholinergic, and serotonergic innervation of RTN represents a possible substrate for the known state-dependent control of RTN chemoreceptors; 3) VGLUT3-ir terminals are a probable marker of RTN; and 4) the chemosensitive neurons of RTN may provide a chemical drive to multiple respiratory outflows, insofar as RTN innervates the entire VRC.
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Affiliation(s)
- Diane L Rosin
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia 22908, USA.
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Ren J, Poon BY, Tang Y, Funk GD, Greer JJ. Ampakines alleviate respiratory depression in rats. Am J Respir Crit Care Med 2006; 174:1384-91. [PMID: 16973981 DOI: 10.1164/rccm.200606-778oc] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE There is a need for improved therapeutic interventions to treat both drug- and sleep-induced respiratory depression. Increased understanding of the neurochemical control of respiration will help identify a basis for advances. Activation of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-type glutamate receptors positively modulates respiratory drive and rhythmogenesis in several brain regions including the pre-Bötzinger complex. Ampakines are a diverse group of small molecules that activate subsets of these receptors. OBJECTIVE We determined whether the ampakine CX546 would enhance respiratory drive and rhythmogenesis across various stages of development and whether this ampakine could counter opioid- and barbiturate-induced respiratory depression. METHODS Respiratory frequency and amplitude were measured in the following rat models: (1) perinatal in vitro brainstem-spinal cord, (2) neonatal in vitro medullary slice, (3) juvenile in situ perfused, working heart-brainstem preparation, and (4) newborn and adult in vivo. RESULTS Administration of CX546 stimulated baseline respiratory frequency in perinatal in vitro preparations but not in older animals (greater than Postnatal Day 0). Furthermore, pharmacologic depression of respiratory frequency and amplitude was countered at all ages studied by the administration of CX546 in vitro, in situ, and in vivo. Significantly, CX546 countered opioid-induced breathing depression in all preparations, without altering analgesia as assessed by measuring the time to foot withdrawal in response to a thermal stimulus. CONCLUSIONS CX546 effectively reverses opioid- and barbiturate-induced respiratory depression without reversing the analgesic response. These studies suggest that ampakines may be useful in preventing or reversing opioid-induced respiratory depression and identify the potential of ampakines for alleviating other forms of respiratory depression including sedative use and sleep apnea.
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Affiliation(s)
- Jun Ren
- Department of Physiology, University of Alberta, 513 HMRC, Edmonton, AB, T6G 2S2 Canada
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Baldwin DN, Pillow JJ, Stocks J, Frey U. Lung-function tests in neonates and infants with chronic lung disease: tidal breathing and respiratory control. Pediatr Pulmonol 2006; 41:391-419. [PMID: 16555264 DOI: 10.1002/ppul.20400] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper is the fourth in a series of reviews that will summarize available data and critically discuss the potential role of lung-function testing in infants with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses information derived from tidal breathing measurements within the framework outlined in the introductory paper of this series, with particular reference to how these measurements inform on control of breathing. Infants with acute and chronic respiratory illness demonstrate differences in tidal breathing and its control that are of clinical consequence and can be measured objectively. The increased incidence of significant apnea in preterm infants and infants with chronic lung disease, together with the reportedly increased risk of sudden unexplained death within the latter group, suggests that control of breathing is affected by both maturation and disease. Clinical observations are supported by formal comparison of tidal breathing parameters and control of breathing indices in the research setting.
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Affiliation(s)
- David N Baldwin
- Centre for Child Health Research and Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
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Takakura ACT, Moreira TS, Colombari E, West GH, Stornetta RL, Guyenet PG. Peripheral chemoreceptor inputs to retrotrapezoid nucleus (RTN) CO2-sensitive neurons in rats. J Physiol 2006; 572:503-23. [PMID: 16455687 PMCID: PMC1779666 DOI: 10.1113/jphysiol.2005.103788] [Citation(s) in RCA: 248] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Accepted: 01/31/2006] [Indexed: 12/11/2022] Open
Abstract
The rat retrotrapezoid nucleus (RTN) contains pH-sensitive neurons that are putative central chemoreceptors. Here, we examined whether these neurons respond to peripheral chemoreceptor stimulation and whether the input is direct from the solitary tract nucleus (NTS) or indirect via the respiratory network. A dense neuronal projection from commissural NTS (commNTS) to RTN was revealed using the anterograde tracer biotinylated dextran amine (BDA). Within RTN, 51% of BDA-labelled axonal varicosities contained detectable levels of vesicular glutamate transporter-2 (VGLUT2) but only 5% contained glutamic acid decarboxylase-67 (GAD67). Awake rats were exposed to hypoxia (n = 6) or normoxia (n = 5) 1 week after injection of the retrograde tracer cholera toxin B (CTB) into RTN. Hypoxia-activated neurons were identified by the presence of Fos-immunoreactive nuclei. CommNTS neurons immunoreactive for both Fos and CTB were found only in hypoxia-treated rats. VGLUT2 mRNA was detected in 92 +/- 13% of these neurons whereas only 12 +/- 9% contained GAD67 mRNA. In urethane-chloralose-anaesthetized rats, bilateral inhibition of the RTN with muscimol eliminated the phrenic nerve discharge (PND) at rest, during hyperoxic hypercapnia (10% CO(2)), and during peripheral chemoreceptor stimulation (hypoxia and/or i.v. sodium cyanide, NaCN). RTN CO(2)-activated neurons were recorded extracellularly in anaesthetized intact or vagotomized rats. These neurons were strongly activated by hypoxia (10-15% O(2); 30 s) or by NaCN. Hypoxia and NaCN were ineffective in rats with carotid chemoreceptor denervation. Bilateral injection of muscimol into the ventral respiratory column 1.5 mm caudal to RTN eliminated PND and the respiratory modulation of RTN neurons. Muscimol did not change the threshold and sensitivity of RTN neurons to hyperoxic hypercapnia nor their activation by peripheral chemoreceptor stimulation. In conclusion, RTN neurons respond to brain P(CO(2)) presumably via their intrinsic chemosensitivity and to carotid chemoreceptor activation via a direct glutamatergic pathway from commNTS that bypasses the respiratory network. RTN neurons probably contribute a portion of the chemical drive to breathe.
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