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Gerhardy B, Sivapathan S, Orde S, Morgan L. Simultaneous Cardiopulmonary Exercise Testing and Echocardiography for Investigation of Cardiopulmonary Dysfunction in Outpatients: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e52076. [PMID: 38345834 PMCID: PMC10897791 DOI: 10.2196/52076] [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: 08/22/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Cardiopulmonary dysfunction is a complex process with a broad range of etiologies. Investigations performed either at rest or those that only assess the function of a single organ (heart or lungs) are often insufficient. A simultaneous cardiopulmonary exercise test with stress echocardiography is a new approach to assessing cardiopulmonary dysfunction as it provides anatomical and functional imaging simultaneously while under increasing stress. To date, the application of cardiopulmonary exercise test-stress echocardiography (CPET-SE) has been broad and without structure, and its effect on patient outcomes is unclear. OBJECTIVE The objective of this scoping review is to explore and analyze the evidence regarding the role of simultaneous CPET-SE in investigating cardiopulmonary dysfunction in outpatients. It will include any published study in which adult (older than or equal to 18 years of age) patients have completed a CPET-SE for the investigation of cardiopulmonary dysfunction. METHODS This review will follow the Arksey and O'Malley framework, supported by the Joanna Briggs Institute methodology for scoping reviews. It will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Data sources will include MEDLINE, Scopus, Embase, and Cochrane (including reviews, trials, and protocols) electronic databases, with no date range defined. The search will be limited to the English language with no restrictions regarding pathology. Secondary references of the included sources will also be assessed by a hand search for suitability. A 2-person title-abstract screen and data charting process will be used. Independent experts will be used for consultation including an academic librarian and clinicians. The Covidence software will be used for article screening. RESULTS This scoping review will provide a unified and detailed description of the applications of CPET-SE in investigating cardiopulmonary dysfunction. This will provide a platform for future research harnessing this investigatory method. The results will be presented in both tabular and graphical formats to ensure clarity. The results of this scoping review will be submitted to a relevant peer-reviewed academic journal for publication. CONCLUSIONS The CPET-SE is a powerful tool for investigating cardiopulmonary dysfunction but remains in its infancy with a patchwork approach to indications, data reporting, and interpretation. This scoping review will unify the literature and provide a platform for future researchers and the development of a comprehensive application guideline. TRIAL REGISTRATION Open Science Framework; https://osf.io/98r3e. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52076.
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Affiliation(s)
- Benjamin Gerhardy
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, Australia
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine and Health Sciences, University of Sydney, Kingswood, Australia
| | - Shanthosh Sivapathan
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine and Health Sciences, University of Sydney, Kingswood, Australia
| | - Sam Orde
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine and Health Sciences, University of Sydney, Kingswood, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine and Health Sciences, University of Sydney, Kingswood, Australia
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, Australia
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Cialoni D, Brizzolari A, Sponsiello N, Lancellotti V, Bosco G, Marroni A, Barassi A. Serum Amino Acid Profile Changes After Repetitive Breath-Hold Dives: A Preliminary Study. SPORTS MEDICINE - OPEN 2022; 8:80. [PMID: 35723766 PMCID: PMC9209628 DOI: 10.1186/s40798-022-00474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022]
Abstract
Background The aim of this work was to investigate the serum amino acid (AA) changes after a breath-hold diving (BH-diving) training session under several aspects including energy need, fatigue tolerance, nitric oxide (NO) production, antioxidant synthesis and hypoxia adaptation. Twelve trained BH-divers were investigated during an open sea training session and sampled for blood 30 min before the training session, 30 min and 4 h after the training session. Serum samples were assayed for AA changes related to energy request (alanine, histidine, isoleucine, leucine, lysine, methionine, proline threonine, valine), fatigue tolerance (ornithine, phenylalanine, tyrosine), nitric oxide production (citrulline), antioxidant synthesis (cystine, glutamate, glycine) and hypoxia adaptation (serine, taurine). Main results Concerning the AA used as an energy support during physical effort, we found statistically significant decreases for all the investigated AA at T1 and a gradual return to the basal value at T2 even if alanine, proline and theonine still showed a slight significant reduction at this time. Also, the changes related to the AA involved in tolerance to physical effort showed a statistically significant decrease only at T1 respect to pre-diving value and a returned to normal value at T2. Citrulline, involved in NO production, showed a clear significant reduction both at T1 and T2. Concerning AA involved in endogenous antioxidant synthesis, the behaviour of the three AA investigated is different: we found a statistically significant increase in cystine both at T1 and T2, while glycine showed a statistically significant reduction (T1 and T2). Glutamate did not show any statistical difference. Finally, we found a statistically significant decrease in the AA investigated in other hypoxia conditions serine and taurine (T1 and T2). Conclusions Our data seem to indicate that the energetic metabolic request is in large part supported by AA used as substrate for fuel metabolism and that also fatigue tolerance, NO production and antioxidant synthesis are supported by AA. Finally, there are interesting data related to the hypoxia stimulus that indirectly may confirm that the muscle apparatus works under strong exposure conditions notwithstanding the very short/low intensity of exercise, due to the intermittent hypoxia caused by repetitive diving.
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Kelly T, Brown C, Bryant-Ekstrand M, Lord R, Dawkins T, Drane A, Futral JE, Barak O, Dragun T, Stembridge M, Spajić B, Drviš I, Duke JW, Ainslie PN, Foster GE, Dujic Z, Lovering AT. Blunted hypoxic pulmonary vasoconstriction in apnoea divers. Exp Physiol 2022; 107:1225-1240. [PMID: 35993480 DOI: 10.1113/ep090326] [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: 01/13/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is new and noteworthy? What is the central question of this study? Does the hyperbaric, hypercapnic, acidotic, hypoxic stress of apnoea diving lead to greater pulmonary vasoreactivity and increased right-heart work in apnoea divers? What is the main finding and its importance? Compared to sex- and age-matched controls, Divers had a significantly lower change in total pulmonary resistance in response to short duration isocapnic hypoxia. With oral sildenafil (50 mg), there were no differences in total pulmonary resistance between groups, suggesting Divers can maintain normal pulmonary artery tone in hypoxic conditions. Blunted hypoxic pulmonary vasoconstriction may be beneficial during apnoea diving. ABSTRACT Competitive apnoea divers repetitively dive to depths beyond 50 m. During the final portions of ascent, Divers experience significant hypoxaemia. Additionally, hyperbaria during diving increases thoracic blood volume while simultaneously reducing lung volume, increasing pulmonary artery pressure. We hypothesized that Divers would have exaggerated hypoxic pulmonary vasoconstriction leading to increased right-heart work due to their repetitive hypoxaemia and hyperbaria, and that the administration of sildenafil would have a greater effect in reducing pulmonary resistance in Divers. We recruited 16 Divers and 16 age and sex matched non-diving controls (Controls). Using a double-blinded, placebo-controlled, cross-over design, participants were evaluated for normal cardiac and lung function, then their cardiopulmonary responses to 20-30 minutes of isocapnic hypoxia (end-tidal PO2 = 50 mm Hg) were measured one hour following ingestion of 50 mg sildenafil or placebo. Cardiac structure and cardiopulmonary function were similar at baseline. With placebo, Divers had a significantly smaller increase in total pulmonary resistance than controls after 20-30 minutes isocapnic hypoxia (Δ -3.85 ± 72.85 vs 73.74 ± 91.06 dynes/sec/cm-5 , p = .0222). With sildenafil, Divers and Controls had similarly blunted increases in total pulmonary resistance after 20-30 minutes of hypoxia. Divers also had a significantly lower systemic vascular resistance following sildenafil in normoxia. These data indicate that repetitive apnoea diving leads to a blunted hypoxic pulmonary vasoconstriction. We suggest this is a beneficial adaption allowing for increased cardiac output with reduced right heart work and thus reducing cardiac oxygen utilization under hypoxemic conditions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tyler Kelly
- Department of Human Physiology, University of Oregon, Eugene, Oregon, USA
| | - Courtney Brown
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | | | - Rachel Lord
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Tony Dawkins
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Aimee Drane
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Joel E Futral
- Department of Human Physiology, University of Oregon, Eugene, Oregon, USA
| | - Otto Barak
- Department of Physiology, University of Novi Sad, Novi Sad, Serbia
| | - Tanja Dragun
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Michael Stembridge
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Boris Spajić
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Ivan Drviš
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Joseph W Duke
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Philip N Ainslie
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Glen E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Zeljko Dujic
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, Oregon, USA
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Hendriks-Balk MC, Damianaki A, Polychronopoulou E, Brito W, Pruijm M, Wuerzner G. Contrast-Enhanced Ultrasonography Enables the Detection of a Cold Pressor Test-Induced Increase in Renal Microcirculation in Healthy Participants. Front Cardiovasc Med 2022; 9:899327. [PMID: 35669471 PMCID: PMC9163379 DOI: 10.3389/fcvm.2022.899327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRenal microcirculation is essential for regulation of the glomerular filtration rate, the reabsorption of salt and water from the interstitium, and hence the blood pressure. Renal ultrasonography coupled to Doppler analysis and contrast-enhanced ultrasound enables the study of renal perfusion. So far, physiologic interventions have rarely been performed to assess the renal perfusion. The objective of our study was to measure the renal perfusion in response to a cold pressor test (CPT).MethodsHealthy adult participants were exposed to a 2 min CPT or a sham exposure (body temperature). Systemic hemodynamics, renal resistive index (RRI) and renal perfusion index (PI) were measured before and during the CPT or the sham exposure. Renal responses were compared using a paired Student's t-test or Wilcoxon signed rank test. Pearson correlation test was used to test association of variables of interest.ResultsForty-one normotensive participants (21 women) were included in the study. Mean blood pressure and heart rate both increased with the CPT. The RRI decreased from 0.60 ± 0.05 arbitrary units (AU) to 0.58 ± 0.05 AU (p < 0.05) and the PI increased from 2,074 AU (1,358–3,346) to 3,800 AU (2,118–6,399) (p < 0.05) (+66% (24–106%)). Compared to the sham exposure, the increase in PI with the CPT was more marked. There was a negative association between the increase in heart rate and mean blood pressure with the RRI (r: −0.550, p = 0.002 and r: −0.395, P = 0.016), respectively.ConclusionDoppler Ultrasound and CEUS enable the detection of physiological changes within the macro- and microvascular renal circulation. The CPT decreases the RRI and increases the PI. Whether these changes are present in pathological states such as diabetes or hypertension will need additional studies.
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Serum Cardiac and Skeletal Muscle Marker Changes in Repetitive Breath-hold Diving. SPORTS MEDICINE-OPEN 2021; 7:58. [PMID: 34417928 PMCID: PMC8380208 DOI: 10.1186/s40798-021-00349-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022]
Abstract
Background Breath-hold diving (BH-diving) is associated to extreme environmental conditions, prolonged physical activity, and complex adaptation mechanisms to supply enough O2 to vital organs. Consequently, one of the biggest effects could be an increased exercise-induced muscle fatigue, in both skeletal and cardiac muscles that can induce an increase of muscles injury markers including creatine kinase (CK), aspartate transferase (AST), and alanine transferase (ALT) when concerning the skeletal muscle, cardiac creatine kinase isoenzyme (CK-MBm) and cardiac troponin I (cTnI) when concerning the cardiac muscle, and lactate dehydrogenase (LDH) as index of muscle stress. The aim of this study is to investigate serum cardiac and skeletal muscle markers before and after a BH-diving training session. Results We found statistically significant increases of CK (T0: 136.1% p < 0.0001; T1: 138.5%, p < 0.0001), CK-MBm (T0: 145.1%, p < 0.0001; T1: 153.2%, p < 0.0001) LDH (T0: 110.4%, p < 0.0003; T1: 110.1%, p < 0.0013) in both T0 and T1 blood samples, as compared to basal value. AST showed a statistically significant increase only at T0 (106.8%, p < 0.0007) while ALT did not exhibit statistically significant changes. We did not find any changes in cTnI levels between pre-dive and post-dive samples. Conclusions Our data seem to indicate that during a BH-diving training session, skeletal and cardiac muscles react to physical effort releasing stress-related substances. Although the peculiar nature of BH-diving makes it difficult to understand if our results are related only to exercise induced muscle adaptation or whether acute hypoxia or a response to environmental changes (pressure) play a role to explain the observed changes, further studies are needed to better understand if these biomarker changes are linked to physical exercise or to acute hypoxia, or if both conditions play a role. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00349-z.
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Patrician A, Dujić Ž, Spajić B, Drviš I, Ainslie PN. Breath-Hold Diving - The Physiology of Diving Deep and Returning. Front Physiol 2021; 12:639377. [PMID: 34093221 PMCID: PMC8176094 DOI: 10.3389/fphys.2021.639377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Breath-hold diving involves highly integrative physiology and extreme responses to both exercise and asphyxia during progressive elevations in hydrostatic pressure. With astonishing depth records exceeding 100 m, and up to 214 m on a single breath, the human capacity for deep breath-hold diving continues to refute expectations. The physiological challenges and responses occurring during a deep dive highlight the coordinated interplay of oxygen conservation, exercise economy, and hyperbaric management. In this review, the physiology of deep diving is portrayed as it occurs across the phases of a dive: the first 20 m; passive descent; maximal depth; ascent; last 10 m, and surfacing. The acute risks of diving (i.e., pulmonary barotrauma, nitrogen narcosis, and decompression sickness) and the potential long-term medical consequences to breath-hold diving are summarized, and an emphasis on future areas of research of this unique field of physiological adaptation are provided.
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Affiliation(s)
- Alexander Patrician
- Center for Heart, Lung & Vascular Health, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Željko Dujić
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Boris Spajić
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Ivan Drviš
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Philip N Ainslie
- Center for Heart, Lung & Vascular Health, University of British Columbia Okanagan, Kelowna, BC, Canada
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Physiology, pathophysiology and (mal)adaptations to chronic apnoeic training: a state-of-the-art review. Eur J Appl Physiol 2021; 121:1543-1566. [PMID: 33791844 PMCID: PMC8144079 DOI: 10.1007/s00421-021-04664-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
Breath-hold diving is an activity that humans have engaged in since antiquity to forage for resources, provide sustenance and to support military campaigns. In modern times, breath-hold diving continues to gain popularity and recognition as both a competitive and recreational sport. The continued progression of world records is somewhat remarkable, particularly given the extreme hypoxaemic and hypercapnic conditions, and hydrostatic pressures these athletes endure. However, there is abundant literature to suggest a large inter-individual variation in the apnoeic capabilities that is thus far not fully understood. In this review, we explore developments in apnoea physiology and delineate the traits and mechanisms that potentially underpin this variation. In addition, we sought to highlight the physiological (mal)adaptations associated with consistent breath-hold training. Breath-hold divers (BHDs) are evidenced to exhibit a more pronounced diving-response than non-divers, while elite BHDs (EBHDs) also display beneficial adaptations in both blood and skeletal muscle. Importantly, these physiological characteristics are documented to be primarily influenced by training-induced stimuli. BHDs are exposed to unique physiological and environmental stressors, and as such possess an ability to withstand acute cerebrovascular and neuronal strains. Whether these characteristics are also a result of training-induced adaptations or genetic predisposition is less certain. Although the long-term effects of regular breath-hold diving activity are yet to be holistically established, preliminary evidence has posed considerations for cognitive, neurological, renal and bone health in BHDs. These areas should be explored further in longitudinal studies to more confidently ascertain the long-term health implications of extreme breath-holding activity.
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Cardiac hypoxic resistance and decreasing lactate during maximum apnea in elite breath hold divers. Sci Rep 2021; 11:2545. [PMID: 33510292 PMCID: PMC7844051 DOI: 10.1038/s41598-021-81797-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/06/2021] [Indexed: 01/30/2023] Open
Abstract
Breath-hold divers (BHD) enduring apnea for more than 4 min are characterized by resistance to release of reactive oxygen species, reduced sensitivity to hypoxia, and low mitochondrial oxygen consumption in their skeletal muscles similar to northern elephant seals. The muscles and myocardium of harbor seals also exhibit metabolic adaptations including increased cardiac lactate-dehydrogenase-activity, exceeding their hypoxic limit. We hypothesized that the myocardium of BHD possesses similar adaptive mechanisms. During maximum apnea 15O-H2O-PET/CT (n = 6) revealed no myocardial perfusion deficits but increased myocardial blood flow (MBF). Cardiac MRI determined blood oxygen level dependence oxygenation (n = 8) after 4 min of apnea was unaltered compared to rest, whereas cine-MRI demonstrated increased left ventricular wall thickness (LVWT). Arterial blood gases were collected after warm-up and maximum apnea in a pool. At the end of the maximum pool apnea (5 min), arterial saturation decreased to 52%, and lactate decreased 20%. Our findings contrast with previous MR studies of BHD, that reported elevated cardiac troponins and decreased myocardial perfusion after 4 min of apnea. In conclusion, we demonstrated for the first time with 15O-H2O-PET/CT and MRI in elite BHD during maximum apnea, that MBF and LVWT increases while lactate decreases, indicating anaerobic/fat-based cardiac-metabolism similar to diving mammals.
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Elia A, Barlow MJ, Wilson OJ, O'Hara JP. Splenic responses to a series of repeated maximal static and dynamic apnoeas with whole-body immersion in water. Exp Physiol 2020; 106:338-349. [PMID: 32421235 DOI: 10.1113/ep088404] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/13/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Splenic contractions occur in response to apnoea-induced hypoxia with and without face immersion in water. However, the splenic responses to a series of static or dynamic apnoeas with whole-body water immersion in non-divers and elite breath-hold divers are unknown. What is the main finding and its importance? Static and dynamic apnoeas were equally effective in stimulating splenic contractions across non-divers and elite breath-hold divers. These findings demonstrate that the magnitude of the splenic response is largely dictated by the degree of the hypoxemic stress encountered during voluntary apnoeic epochs. ABSTRACT Splenic contractions occur in response to apnoea-induced hypoxia with and without facial water immersion. However, the splenic responses to a series of static (STA) or dynamic (DYN) apnoeas with whole-body water immersion in non-divers (NDs) and elite breath-hold divers (EBHDs) are unknown. EBHD (n = 8), ND (n = 10) and control participants (n = 8) were recruited. EBHD and ND performed a series of five maximal DYN or STA on separate occasions. Control performed a static eupnoeic (STE) protocol to control against any effects of water immersion and diurnal variation on splenic volume and haematology. Heart rate (HR) and peripheral oxygen saturation (SpO2 ) were monitored for 30 s after each apnoea. Pre- and post-apnoeic splenic volumes were quantified ultrasonically, and blood samples were drawn for haematology. For EBHD and ND end-apnoeic HR was higher (P < 0.001) and SpO2 was lower in DYN (P = 0.024) versus STA. EBHD attained lower end-apnoeic SpO2 during DYN and STA than NDs (P < 0.001). Splenic contractions occurred following DYN (EBHD, -47 ± 6%; ND, -37 ± 4%; P < 0.001) and STA (EBHD, -26 ± 4%; ND, -26 ± 8%; P < 0.01). DYN-associated splenic contractions were greater than STA in EBHD only (P = 0.042). Haemoglobin concentrations were higher following DYN only (EBHD, +5 ± 8g/L , +4 ± 2%; ND, +8 ± 3 g/L , +4.9 ± 3%; P = 0.019). Haematocrit remained unchanged after each protocol. There were no between group differences in post-apnoeic splenic volume or haematology. In both groups, splenic contractions occurred in response to STA and DYN when combined with whole-body immersion. DYN apnoeas, were effective at increasing haemoglobin concentrations but not STA apnoeas. Thus, the magnitude of the splenic response relates to the hypoxemic stress encountered during apnoeic epochs.
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Affiliation(s)
- Antonis Elia
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,Division of Environmental Physiology, School of Chemistry, Bioengineering and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Matthew J Barlow
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Oliver J Wilson
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - John P O'Hara
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
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Bain AR, Drvis I, Dujic Z, MacLeod DB, Ainslie PN. Physiology of static breath holding in elite apneists. Exp Physiol 2019; 103:635-651. [PMID: 29512224 DOI: 10.1113/ep086269] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/02/2018] [Indexed: 12/16/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review provides an up-to-date assessment of the physiology involved with extreme static dry-land breath holding in trained apneists. What advances does it highlight? We specifically highlight the recent findings involved with the cardiovascular, cerebrovascular and metabolic function during a maximal breath hold in elite apneists. ABSTRACT Breath-hold-related activities have been performed for centuries, but only recently, within the last ∼30 years, has it emerged as an increasingly popular competitive sport. In apnoea sport, competition relates to underwater distances or simply maximal breath-hold duration, with the current (oxygen-unsupplemented) static breath-hold record at 11 min 35 s. Remarkably, many ultra-elite apneists are able to suppress respiratory urges to the point where consciousness fundamentally limits a breath-hold duration. Here, arterial oxygen saturations as low as ∼50% have been reported. In such cases, oxygen conservation to maintain cerebral functioning is critical, where responses ascribed to the mammalian dive reflex, e.g. sympathetically mediated peripheral vasoconstriction and vagally mediated bradycardia, are central. In defence of maintaining global cerebral oxygen delivery during prolonged breath holds, the cerebral blood flow may increase by ∼100% from resting values. Interestingly, near the termination of prolonged dry static breath holds, recent studies also indicate that reductions in the cerebral oxidative metabolism can occur, probably attributable to the extreme hypercapnia and irrespective of the hypoxaemia. In this review, we highlight and discuss the recent data on the cardiovascular, metabolic and, particularly, cerebrovascular function in competitive apneists performing maximal static breath holds. The physiological adaptation and maladaptation with regular breath-hold training are also summarized, and future research areas in this unique physiological field are highlighted; particularly, the need to determine the potential long-term health impacts of extreme breath holding.
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Affiliation(s)
- Anthony R Bain
- Center for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada.,Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Ivan Drvis
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - David B MacLeod
- Human Pharmacology and Physiology Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Philip N Ainslie
- Center for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
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Schipke JD, Eichhorn L, Behm P, Cleveland S, Kelm M, Boenner F. Glossopharyngeal insufflation and kissing papillary muscles. Scand J Med Sci Sports 2018; 29:299-304. [PMID: 30376212 DOI: 10.1111/sms.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jochen D Schipke
- c/o Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Lars Eichhorn
- Clinic and Policlinic for Anaesthesiology and Operative Intensive Care Medicine, University of Bonn, Bonn, Germany
| | - Patrick Behm
- Clinic for Cardiology, Pneumology & Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sinclair Cleveland
- Institute of Neuro- and Sensory Physiology, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Clinic for Cardiology, Pneumology & Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Florian Boenner
- Clinic for Cardiology, Pneumology & Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
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12
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Stembridge M, Hoiland RL, Bain AR, Barak OF, Drvis I, MacLeod DB, MacLeod DM, Madden D, Batinic T, O'Donoghue P, Shave R, Dujic Z, Ainslie PN. Influence of lung volume on the interaction between cardiac output and cerebrovascular regulation during extreme apnoea. Exp Physiol 2018; 102:1288-1299. [PMID: 28762565 DOI: 10.1113/ep086429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/20/2017] [Indexed: 12/12/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does the reduction in cardiac output observed during extreme voluntary apnoea, secondary to high lung volume, result in a reduction in cerebral blood flow, perfusion pressure and oxygen delivery in a group of elite free divers? What is the main finding and its importance? High lung volumes reduce cardiac output and ventricular filling during extreme apnoea, but changes in cerebral blood flow are observed only transiently during the early stages of apnoea. This reveals that whilst cardiac output is important in regulating cerebral haemodynamics, the role of mean arterial pressure in restoring cerebral perfusion pressure is of greater significance to the regulation of cerebral blood flow. We investigated the role of lung volume-induced changes in cardiac output (Q̇) on cerebrovascular regulation during prolonged apnoea. Fifteen elite apnoea divers (one female; 185 ± 7 cm, 82 ± 12 kg, 29 ± 7 years old) attended the laboratory on two separate occasions and completed maximal breath-holds at total lung capacity (TLC) and functional residual capacity (FRC) to elicit disparate cardiovascular responses. Mean arterial pressure (MAP), internal jugular venous pressure and arterial blood gases were measured via cannulation. Global cerebral blood flow was quantified by ultrasound and cardiac output was quantified by via photoplethysmography. At FRC, stroke volume and Q̇ did not change from baseline (P > 0.05). In contrast, during the TLC trial stroke volume and Q̇ were decreased until 80 and 40% of apnoea, respectively (P < 0.05). During the TLC trial, global cerebral blood flow was significantly lower at 20%, but subsequently increased so that cerebral oxygen delivery was comparable to that during the FRC trial. Internal jugular venous pressure was significantly higher throughout the TLC trial in comparison to FRC. The MAP increased progressively in both trials but to a greater extent at TLC, resulting in a comparable cerebral perfusion pressure between trials by the end of apnoea. In summary, although lung volume has a profound effect on Q̇ during prolonged breath-holding, these changes do not translate to the cerebrovasculature owing to the greater sensitivity of cerebral blood flow to arterial blood gases and MAP; regulatory mechanisms that facilitate the maintenance of cerebral oxygen delivery.
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Affiliation(s)
- Mike Stembridge
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
| | - Ryan L Hoiland
- Centre for Heart Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Anthony R Bain
- Centre for Heart Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Otto F Barak
- School of Medicine, University of Split, Split, Croatia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Drvis
- School of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - David B MacLeod
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | | | - Dennis Madden
- School of Medicine, University of Split, Split, Croatia
| | - Tonci Batinic
- School of Medicine, University of Split, Split, Croatia
| | - Peter O'Donoghue
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
| | - Rob Shave
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
| | - Zeljko Dujic
- School of Medicine, University of Split, Split, Croatia
| | - Philip N Ainslie
- Centre for Heart Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
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Mijacika T, Kyhl K, Frestad D, Otto Barak F, Drvis I, Secher NH, Dujic Z, Lav Madsen P. Effect of pulmonary hyperinflation on central blood volume: An MRI study. Respir Physiol Neurobiol 2017; 243:92-96. [PMID: 28583413 DOI: 10.1016/j.resp.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022]
Abstract
Pulmonary hyperinflation attained by glossopharyngeal insufflation (GPI) challenges the circulation by compressing the heart and pulmonary vasculature. Our aim was to determine the amount of blood translocated from the central blood volume during GPI. Cardiac output and cardiac chamber volumes were assessed by magnetic resonance imaging in twelve breath-hold divers at rest and during apnea with GPI. Pulmonary blood volume was determined from pulmonary blood flow and transit times for gadolinium during first-pass perfusion after intravenous injection. During GPI, the lung volume increased by 0.8±0.6L (11±7%) above the total lung capacity. All cardiac chambers decreased in volume and despite a heart rate increase of 24±29 bpm (39±50%), pulmonary blood flow decreased by 2783±1820mL (43±20%). The pulmonary transit time remained unchanged at 7.5±2.2s and pulmonary blood volume decreased by 354±176mL (47±15%). In total, central blood volume decreased by 532±248mL (46±14%). Voluntary pulmonary hyperinflation leads to ∼50% decrease in pulmonary and central blood volume.
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Affiliation(s)
- Tanja Mijacika
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia
| | - Kasper Kyhl
- The Cardiac MRI group, Dept. Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Daria Frestad
- Dept. of Cardiology, Copenhagen University Hospital, Hvidovre, University of Copenhagen, Denmark
| | - F Otto Barak
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia; Dept. of Physiology, Faculty of Medicine, University of Novi Sad, Serbia
| | - Ivan Drvis
- University of Zagreb Faculty of Kinesiology, Croatia
| | - Niels H Secher
- Dept. of Anesthesiology, The Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Zeljko Dujic
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia.
| | - Per Lav Madsen
- Dept. of Cardiology, Copenhagen University Hospital, Herlev, University of Copenhagen, Denmark
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14
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Mijacika T, Dujic Z. Sports-related lung injury during breath-hold diving. Eur Respir Rev 2017; 25:506-512. [PMID: 27903671 DOI: 10.1183/16000617.0052-2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/01/2016] [Indexed: 12/19/2022] Open
Abstract
The number of people practising recreational breath-hold diving is constantly growing, thereby increasing the need for knowledge of the acute and chronic effects such a sport could have on the health of participants. Breath-hold diving is potentially dangerous, mainly because of associated extreme environmental factors such as increased hydrostatic pressure, hypoxia, hypercapnia, hypothermia and strenuous exercise.In this article we focus on the effects of breath-hold diving on pulmonary function. Respiratory symptoms have been reported in almost 25% of breath-hold divers after repetitive diving sessions. Acutely, repetitive breath-hold diving may result in increased transpulmonary capillary pressure, leading to noncardiogenic oedema and/or alveolar haemorrhage. Furthermore, during a breath-hold dive, the chest and lungs are compressed by the increasing pressure of water. Rapid changes in lung air volume during descent or ascent can result in a lung injury known as pulmonary barotrauma. Factors that may influence individual susceptibility to breath-hold diving-induced lung injury range from underlying pulmonary or cardiac dysfunction to genetic predisposition.According to the available data, breath-holding does not result in chronic lung injury. However, studies of large populations of breath-hold divers are necessary to firmly exclude long-term lung damage.
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Affiliation(s)
- Tanja Mijacika
- Dept of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Zeljko Dujic
- Dept of Integrative Physiology, University of Split School of Medicine, Split, Croatia
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15
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Mijacika T, Frestad D, Kyhl K, Barak O, Drvis I, Secher NH, Buca A, Obad A, Dujic Z, Madsen PL. Blood pooling in extrathoracic veins after glossopharyngeal insufflation. Eur J Appl Physiol 2017; 117:641-649. [PMID: 28243777 DOI: 10.1007/s00421-017-3545-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Trained breath-hold divers hyperinflate their lungs by glossopharyngeal insufflation (GPI) to prolong submersion time and withstand lung collapse at depths. Pulmonary hyperinflation leads to profound hemodynamic changes. METHODS Thirteen divers performed preparatory breath-holds followed by apnea with GPI. Filling of extrathoracic veins was determined by ultrasound and magnetic resonance imaging and peripheral extravasation of fluid was assessed by electrical impedance. Femoral vein diameter was measured by ultrasound throughout the easy-going and struggle phase of apnea with GPI in eight divers in a sub-study. RESULTS After GPI, pulmonary volume increased by 0.8 ± 0.6 L above total lung capacity. The diameter of the superior caval (by 36 ± 17%) and intrathoracic part of the inferior caval vein decreased (by 21 ± 16%), while the diameters of the internal jugular (by 53 ± 34%), hepatic (by 28 ± 40%), abdominal part of the inferior caval (by 28 ± 28%), and femoral veins (by 65 ± 50%) all increased (P < 0.05). Blood volume of the internal jugular, the hepatic, the abdominal part of the inferior caval vein, and the combined common iliac and femoral veins increased by 145 ± 115, 80 ± 88, 61 ± 60, and 183 ± 197%, respectively. In the sub-study, femoral vein diameter increased by 44 ± 33% in the easy-going phase of apnea with GPI, subsequently decreasing by 20 ± 16% during the struggle phase. Electrical impedance remained unchanged over the thigh and forearm, thus excluding peripheral fluid extravasation. CONCLUSIONS GPI leads to heart and pulmonary vessel compression, resulting in redistribution of blood to extrathoracic capacitance veins proximal to venous valves. This is partially reversed by the onset of involuntary breathing movements.
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Affiliation(s)
- Tanja Mijacika
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Daria Frestad
- Department of Cardiology, Copenhagen University Hospital, Hvidovre, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Kyhl
- The Cardiac MRI Group, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Otto Barak
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.,Department of Physiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Drvis
- University of Zagreb School of Kinesiology, Zagreb, Croatia
| | - Niels H Secher
- Department of Anesthesiology, The Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ante Buca
- Department of Radiology, University Hospital Center, Split, Croatia
| | - Ante Obad
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, Herlev, University of Copenhagen, Copenhagen, Denmark
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