Lung volumes and ventilatory responses to high CO2 and low O2 in the ama

Chemoreflex Control as the Cornerstone in Immersion Water Sports: Possible Role on Breath-Hold

Immersion water sports involve long-term apneas; therefore, athletes must physiologically adapt to maintain muscle oxygenation, despite not performing pulmonary ventilation. Breath-holding (i.e., apnea) is common in water sports, and it involves a decrease and increases PaO₂ and PaCO₂, respectively, as the primary signals that trigger the end of apnea. The principal physiological O₂ sensors are the carotid bodies, which are able to detect arterial gases and metabolic alterations before reaching the brain, which aids in adjusting the cardiorespiratory system. Moreover, the principal H⁺/CO₂ sensor is the retrotrapezoid nucleus, which is located at the brainstem level; this mechanism contributes to detecting respiratory and metabolic acidosis. Although these sensors have been characterized in pathophysiological states, current evidence shows a possible role for these mechanisms as physiological sensors during voluntary apnea. Divers and swimmer athletes have been found to displayed longer apnea times than land sports athletes, as well as decreased peripheral O₂ and central CO₂ chemoreflex control. However, although chemosensitivity at rest could be decreased, we recently found marked sympathoexcitation during maximum voluntary apnea in young swimmers, which could activate the spleen (which is a reservoir organ for oxygenated blood). Therefore, it is possible that the chemoreflex, autonomic function, and storage/delivery oxygen organ(s) are linked to apnea in immersion water sports. In this review, we summarized the available evidence related to chemoreflex control in immersion water sports. Subsequently, we propose a possible physiological mechanistic model that could contribute to providing new avenues for understanding the respiratory physiology of water sports.

Going to Extremes of Lung Physiology-Deep Breath-Hold Diving

Breath-hold diving involves environmental challenges, such as water immersion, hydrostatic pressure, and asphyxia, that put the respiratory system under stress. While training and inherent individual factors may increase tolerance to these challenges, the limits of human respiratory physiology will be reached quickly during deep breath-hold dives. Nonetheless, world records in deep breath-hold diving of more than 214 m of seawater have considerably exceeded predictions from human physiology. Investigations of elite breath-hold divers and their achievements revised our understanding of possible physiological adaptations in humans and revealed techniques such as glossopharyngeal breathing as being essential to achieve extremes in breath-hold diving performance. These techniques allow elite athletes to increase total lung capacity and minimize residual volume, thereby reducing thoracic squeeze. However, the inability of human lungs to collapse early during descent enables respiratory gas exchange to continue at greater depths, forcing nitrogen (N₂) out of the alveolar space to dissolve in body tissues. This will increase risk of N₂ narcosis and decompression stress. Clinical cases of stroke-like syndromes after single deep breath-hold dives point to possible mechanisms of decompression stress, caused by N₂ entering the vasculature upon ascent from these deep dives. Mechanisms of neurological injury and inert gas narcosis during deep breath-hold dives are still incompletely understood. This review addresses possible hypotheses and elucidates factors that may contribute to pathophysiology of deep freediving accidents. Awareness of the unique challenges to pulmonary physiology at depth is paramount to assess medical risks of deep breath-hold diving.

Cold adaptation, aging, and Korean women divers haenyeo

BACKGROUND

We have been studying the thermoregulatory responses of Korean breath-hold women divers, called haenyeo, in terms of aging and cold adaptation. During the 1960s to the 1980s, haenyeos received attention from environmental physiologists due to their unique ability to endure cold water while wearing only a thin cotton bathing suit. However, their overall cold-adaptive traits have disappeared since they began to wear wetsuits and research has waned since the 1980s. For social and economic reasons, the number of haenyeos rapidly decreased to 4005 in 2015 from 14,143 in 1970 and the average age of haenyeos is about 75 years old at present.

METHODS

For the past several years, we revisited and explored older haenyeos in terms of environmental physiology, beginning with questionnaire and field studies and later advancing to thermal tolerance tests in conjunction with cutaneous thermal threshold tests in a climate chamber. As control group counterparts, older non-diving females and young non-diving females were compared with older haenyeos in the controlled experiments.

RESULTS

Our findings were that older haenyeos still retain local cold tolerance on the extremities despite their aging. Finger cold tests supported more superior local cold tolerance for older haenyeos than for older non-diving females. However, thermal perception in cold reflected aging effects rather than local cold acclimatization. An interesting finding was the possibility of positive cross-adaptation which might be supported by greater heat tolerance and cutaneous warm perception thresholds of older haenyeos who adapted to cold water.

CONCLUSIONS

It was known that cold-adaptive traits of haenyeos disappeared, but we confirmed that cold-adaptive traits are still retained on the face and hands which could be interpreted by a mode switch to local adaptation from the overall adaptation to cold. Further studies on cross-adaptation between chronic cold stress and heat tolerance are needed.

Diving bradycardia of elderly Korean women divers, haenyeo, in cold seawater: a field report

The purpose of the present field study was to explore diving patterns and heart rate of elderly Korean women divers (haenyeo) while breath-hold diving in cold seawater. We hypothesized that the decreasing rate in heart rate of elderly haenyeos during breath-hold diving was greater and total diving time was shorter than those of young haenyeos from previous studies. Nine haenyeos participated in a field study [68 ± 10 yr in age, ranged from 56 to 83 yr] at a seawater temperature of 10 to 13 °C. Average total diving time including surface swimming time between dives was 253 ± 73 min (155-341 min). Total frequency of dives was 97 ± 28 times and they dived 23 ± 8 times per hour. All haenyeos showed diving bradycardia with a decreased rate of 20 ± 8% at the bottom time (101 ± 20 bpm) when compared to surface swimming time (125 ± 16 bpm) in the sea. Older haenyeos among the nine elderly haenyeos had shorter diving time, less diving frequencies, and lower heart rate at work (p<0.05). These reductions imply that haenyeos voluntarily adjust their workload along with advancing age and diminished cardiovascular functions.

Seasonal variation in basal metabolic rates among the Yakut (Sakha) of Northeastern Siberia

OBJECTIVES

Previous research has shown that indigenous circumpolar populations have elevated basal metabolic rates (BMRs), yet few studies have explored whether metabolic rates increase during the winter. This study addresses this gap by examining seasonal variation in BMR and its associations with thyroid function and lifestyle factors among the Yakut (Sakha) of Siberia.

METHODS

Anthropometric dimensions, BMR, and thyroid hormone levels (free triiodothyronine [fT3], free thyroxine [fT4], thyroid-stimulating hormone [TSH]) were measured on two occasions (July/August, 2009 and January 2011) on a sample of 94 Yakut (Sakha) adults (35 men, 59 women) from the rural village of Berdygestiakh, Sakha Republic, Russia.

RESULTS

Seasonal changes in BMR varied by age. Younger Yakut adults (19-49 years) showed significant elevations in winter-time BMR of 6% (P < 0.05), whereas older individuals (≥50 years) showed modest declines (2%; n.s.). Both younger and older Yakut men and women showed increased respiratory quotients during the winter. FT3 and fT4 levels significantly declined during the winter in both younger and older Yakut men and women (P < 0.05). Lifestyle factors were significant predictors of BMR variation, particularly among older men and women.

CONCLUSIONS

Among the Yakut, increased wintertime BMR was observed among younger but not older adults, whereas all adults showed sharp reductions in free thyroid hormone levels during the winter. Among men, greater participation in subsistence activities was associated with increased BMRs and greater fat oxidation. Among women, variation in food use had the strongest impact on metabolic function.

Maintenance of vital capacity during repetitive breath-hold in a spearfishing competition

BACKGROUND AND OBJECTIVE

Cough and a reduction in vital capacity have recently been reported following breath-hold dives to depths of 25-75 m. We sought to investigate whether repetitive dives to depths of less than 30 m would elicit similar effects.

METHODS

Participants in a single-day spearfishing competition were recruited. Subjects performed spirometry before and after the 5-h event. Demographics, medical and diving history, respiratory symptoms and competition diving statistics were collected.

RESULTS

Twenty-five subjects (two females), age 33 years (11) (mean (SD)), were studied. During the competition each subject completed 76 (33) dives, to 10 (3) m depth, with each dive lasting 0.9 (0.3) min. Maximum depth was 17 (4) m. No respiratory symptoms were reported. There was no difference in spirometry before and after competition except for FEF(25-75%), which increased by 0.16(0.34) L (P < 0.05).

CONCLUSIONS

Pulmonary oedema or lung injury is not common after repetitive breath-hold diving to depths to 25 m, or is too mild to be reflected in symptoms or spirometry.

Predictors of increased PaCO2 during immersed prone exercise at 4.7 ATA

During diving, arterial Pco(2) (Pa(CO(2))) levels can increase and contribute to psychomotor impairment and unconsciousness. This study was designed to investigate the effects of the hypercapnic ventilatory response (HCVR), exercise, inspired Po(2), and externally applied transrespiratory pressure (P(tr)) on Pa(CO(2)) during immersed prone exercise in subjects breathing oxygen-nitrogen mixes at 4.7 ATA. Twenty-five subjects were studied at rest and during 6 min of exercise while dry and submersed at 1 ATA and during exercise submersed at 4.7 ATA. At 4.7 ATA, subsets of the 25 subjects (9-10 for each condition) exercised as P(tr) was varied between +10, 0, and -10 cmH(2)O; breathing gas Po(2) was 0.7, 1.0, and 1.3 ATA; and inspiratory and expiratory breathing resistances were varied using 14.9-, 11.6-, and 10.2-mm-diameter-aperture disks. During exercise, Pa(CO(2)) (Torr) increased from 31.5 +/- 4.1 (mean +/- SD for all subjects) dry to 34.2 +/- 4.8 (P = 0.02) submersed, to 46.1 +/- 5.9 (P < 0.001) at 4.7 ATA during air breathing and to 49.9 +/- 5.4 (P < 0.001 vs. 1 ATA) during breathing with high external resistance. There was no significant effect of inspired Po(2) or P(tr) on Pa(CO(2)) or minute ventilation (Ve). Ve (l/min) decreased from 89.2 +/- 22.9 dry to 76.3 +/- 20.5 (P = 0.02) submersed, to 61.6 +/- 13.9 (P < 0.001) at 4.7 ATA during air breathing and to 49.2 +/- 7.3 (P < 0.001) during breathing with resistance. We conclude that the major contributors to increased Pa(CO(2)) during exercise at 4.7 ATA are increased depth and external respiratory resistance. HCVR and maximal O(2) consumption were also weakly predictive. The effects of P(tr), inspired Po(2), and O(2) consumption during short-term exercise were not significant.

Diversity in and adaptation to breath-hold diving in humans

Several features of potential adaptation to breath-hold diving in diving populations and extreme divers are reviewed. Thermal adaptation consists of an improvement in cold tolerance, as witnessed by a decrease in critical water temperature, and implies an elevation of the shivering threshold associated with a greater body insulation. This is indicative of either a strong peripheral vasoconstriction or a more effective countercurrent heat exchange. Respiratory adaptation consists of a blunted ventilatory response to carbon dioxide and an enlargement of lung volumes. Finally, the occurrence of a diving response has been demonstrated. An extreme peripheral vasoconstriction is associated with a dramatic increase in arterial blood pressure. The consequent stimulation of arterial baroreceptors causes an extreme drop of heart rate. Bradycardia is not compensated by a higher stroke volume, with consequent decrease in cardiac output. This decrease, however, is not such as to undermine perfusion to vital organs. Redistribution of blood flow occurs, and some organs such as skeletal muscle may become unperfused, as indicated by the high blood lactate concentrations at low metabolic rate. It is not possible to state, however, whether these changes reflect genetic adaptations or an adaptive response to a prolonged environmental stress.

Cardiorespiratory responses to hypoxia and hypercapnia at rest in vocalists

In order to clarify whether or not ventilatory and circulatory responses to hypoxia and hypercapnia at rest in male vocalists (n = 11) are identical to those of untrained subjects (n = 11), ventilatory responses to hypoxia (HVR) and hypercapnia (HCVR) were estimated as the slope of regression relating .VI to SaO(2) (Delta.VI/DeltaSaO(2)) or the slope factor (A) for the .VI-PETO(2) curve, and as the slope of regression relating .VI to PETCO(2) (Delta.VI/DeltaPETCO(2)), respectively. The respiratory frequency (f), tidal volume (VT), heart rate (HR), and blood pressure (BP) responses to hypoxia and hypercapnia were also estimated as the slope of the line calculated by linear regression related to SaO(2) and PETCO(2). Mean values of Delta.VI/DeltaSaO(2) and A as an index of hypoxic ventilatory response were lower in the vocalist group (0.39 +/- 0.25 l.min(-1).%(-1) and 76.8 +/- 55.7 l.min(-1).torr(-1)) than that in the control group (0.56 +/- 0.46 l.min(-1).%(-1) and 101.6 +/- 85.4 l.min(-1).torr(-1)), and there was no statistically significant difference. The Deltaf/DeltaSaO(2) was significantly (plt;0.05 ) lower in the vocalist group (-0.02 +/- 0.39 breaths.min(-1).%(-1)) than that in the control group (0.43 +/- 0.65 breaths.min(-1).%(-1)). In contrast, mean values of Delta.VI/DeltaPETCO(2) per body mass index were significantly (p<0.05) lower in the vocalist group (0.05 +/- 0.03 l.min(-1).torr(-1)) than those in the control group (0.10 +/- 0.06l.min(-1).torr(-1)). There were also significant differences in DeltaVT/DeltaPETCO(2) and Deltaf/DeltaPETCO(2) between the two groups (p<0.05). However, no significant differences in HR and BP responses to hypoxia and hypercapnia between the two groups were observed. These results suggest that the magnitude of ventilatory response, but not HR and BP, to hypoxia and hypercapnia at rest in vocalists is reduced by chronic vocal training, including breath control and elongation of phonation for long periods.

Hypoxic ventilatory response predicts the extent of maximal breath-holds in man

To understand the factors influencing breath-holding performance, we tested whether the hypoxic (HVR) and hypercapnic ventilatory responses (HCVR) were predictors of the extent of maximal breath-holds as measured by breath-hold duration, the lowest oxyhemoglobin saturation (SpO2min), lowest calculated PaO2 (PaO2min) and highest end-tidal PCO2 (PETCO2max) reached. Steady state isocapnic HVR and hyperoxic HCVR were measured in 17 human volunteers. Breath-holds were made at total lung capacity (TLC), at TLC following hyperventilation, at functional residual capacity, and at TLC with FIO2 = 0.15. SpO2 was measured continuously by pulse oximetry, and alveolar gas was measured at the end of breath-holds by mass spectrometry. PaO2min was calculated from SpO2min and PETCO2max. HVR was a significant predictor of both SpO2min and PaO2min. HVR and forced vital capacity were predictors of breath-hold duration by multiple linear regression. HCVR had no significant predictive value. We conclude that HVR, but not HCVR, is a significant predictor of breath-holding performance.

Ventilatory responses to hypercapnia and hypoxia in elite breath-hold divers

It was recently hypothesized that elite breath-hold divers may display blunted ventilatory responses to hypoxia and/or hypercapnia (Ferretti et al., J. Appl. Physiol. 70: 794-802, 1991). To test this hypothesis, the following measurements were made on three elite breath-hold divers (members of the same family), and on 9 healthy untrained control subjects (C): (1) Steady-state pulmonary ventilation (VE) at rest in the supine posture while breathing room air or normoxic CO2-enriched mixtures. (2) Breath-by-breath VE changes (delta VE), with respect to baseline conditions, after 4 breaths of 100% O2, under the following conditions: normoxia (PIO2 = 146 Torr) at rest (NR); normoxic exercise (60 watt on a bicycle ergometer) (NE); hypoxia (PIO2 = 77 Torr) at rest (HR); hypoxic exercise (HE). The results were as follows: (1) In hypercapnic experiments VE (normalized per unit of body surface area) was significantly lower in the divers than in C (4.32 +/- 0.04 [mean +/- SD]L.min-1.m-2 vs. 5.31 +/- 0.62 at FICO2 = 1.5%; 5.21 +/- 0.17 vs. 7.72 +/- 1.39 at FICO2 = 3%; 8.86 +/- 0.76 vs. 13.14 +/- 2.27 at FICO2 = 5%), as well as than in subjects described by previous authors as being characterized by 'low CO2 sensitivity'. (2) The 100% O2-breathing maneuvers did not induce significant delta VE both in NR and in HR, whereas peak delta VE were -6.73 +/- 1.38 L.min-1 (divers) vs. -5.24 +/- 3.10 (C) in NE, and -17.39 +/- 4.92 (divers) vs. -17.52 +/- 6.32 (C) in HE (no significant differences). It is concluded that the divers, compared to C, had a blunted ventilatory response to hypercapnia, but not to hypoxia. The former may represent an adaptive or genetically inherited phenomenon.

Pulmonary function of a firemen-diver population: a longitudinal study

Non smoking, male professional firemen-divers (n = 20) underwent two pulmonary function tests (PFT) separated by 8-9 years. Measured data were compared to European Coal Steel Community recommended reference values to permit cross-sectional and then longitudinal studies. Higher vital capacity (VC) and forced expiratory volume in 1 s (FEV1; both P < 0.001), and lower residual volume (P < 0.01) were observed in both PFT. Longitudinal analysis showed a smaller VC reduction than FEV1 reduction, leading to a FEV1/VC percentage decrease with time. Maximal mid expiratory flow (MMEF) and MMEF/VC changes during this 9-year period showed an unusually pronounced decrease, suggesting possible chronic effects of diving on small airways. Thus, it is suggested from our observations that a hyperbaric stimulus compensates in part for the effects of aging on VC and that obstructive disease could occur in subjects with long diving experience.

Renal response to head-out water immersion in Korean women divers

Head-out water immersion (HOI) induces a profound diuresis and natriuresis, which may endanger the body fluid balance of breath-hold divers during prolonged diving work. To investigate if adaptation is acquired by professional breath-hold divers, we have evaluated renal responses to 3-h HOI in 5 Korean women divers (Amas) and 11 nondiving housewives (controls). In both control and diver groups, the average urine flow during 3-h immersion was four times greater and Na+ excretion was 70%-80% greater than the pre-immersion value [urine flow: 3.7 (SD 1.0) ml.min-1 vs 0.9 (SD 0.4), P < 0.001, in controls; 4.3 (SD 0.9) vs 1.1 (SD 0.4), P < 0.001, in divers; Na+ excretion: 270 (SD 176) mumol.min-1 vs 161 (SD 84), P < 0.025, in controls; 303 (SD 31) vs 164 (SD 62), P < 0.005, in divers]. In all cases, the values for a given period were not significantly different between the two groups. The plasma concentrations of Na+ and osmolality, and renal clearance of creatinine did not change significantly. However, the osmolal clearance increased [from 2.0 (SD 0.8) ml.min-1 to 2.8 (SD 0.7), P < 0.05, in the controls; from 2.2 (SD 0.4) to 2.6 (SD 0.4), P < 0.05, in the divers] and free water clearance changed from negative to positive values [from -1.1 (SD 0.5) ml.min-1 to 1.2 (SD 0.3), P < 0.005, in the controls; from -1.2 (SD 0.4) to 1.6 (SD 1.1), P < 0.01, in the divers] during immersion, again the pattern of change being similar in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The CO2 responsiveness and ventilatory response to leg and arm exercise in female swimmers

The primary purpose of this study was to compare the ventilatory response to CO2 during rebreathing (delta VI/delta PCO2) among 8 competitive synchronized swimmers (SS), 8 competitive speed swimmers (CS) and 8 recreation swimmers (RS) who acted as controls. A secondary purpose was to study the relationship between delta VI/delta PCO2 and the ventilatory equivalent to the metabolic CO2 output (delta VE/delta VCO2) during graded exercise consisting of treadmill walking and arm cranking. No significant difference was observed amongst the groups in either the intercept or slope of the ventilatory response to increasing alveolar PCO2 was 1.48 +/- 0.33, 2.04 +/- 0.13 and 1.87 +/- 0.18 (mean +/- SEM) in the SS, CS and RS, respectively. The delta VI/delta PCO2 during rebreathing; delta VI/delta PCO2 during rebreathing was not significantly related to the delta VE/delta VCO2 obtained during either treadmill walking or arm cranking. The delta VE/delta VCO2 achieved during treadmill walking was similar for the 3 groups. However, during arm cranking, the delta VE/delta VCO2 was similar for the SS and CS, but both values were significantly lower than the delta VE/delta VCO2 achieved by the RS. It appears that the training regime experienced by the SS and CS did not alter their responsiveness to CO2 during rebreathing. The reduced delta VE/delta VCO2 observed during exercise with the trained limbs (arms) in the SS and CS compared to RS cannot be explained by altered responsiveness to CO2 secondary to training.

Ventilatory response to hypercapnia in sprint and long-distance swimmers

Ventilatory response lines to carbon dioxide at rest were determined by the rebreathing method in 10 untrained subjects, 17 sprint swimmers, and 11 long-distance swimmers. It was found that the mean slope of the ventilatory response line of the swimmer was lower than that of untrained group, and the mean slope of the long distance swimmer was lower as compared with the sprint swimmer, though these differences were statistically not significant. The differences in the hypercapnic drive between untrained subjects and swimmers obtained here is discussed in connection with their maximum oxygen uptake.

Physical characteristics and ventilatory function of 404 commercial divers working in the North Sea

The physical characteristics and simple lung ventilatory indices (FVC, FEV 1, FEV 1/FVC) of 404 commercial divers employed by companies operating in the North Sea were analysed. These findings were correlated with the diving experience and maximum operating depth of each diver. All the divers were men of average height 176-9 cm, and weight 77-1 kg which is greater than average for active Western males, but only 6% were more than 120% of their predicted weight. The average duration of commercial diving was 7-1 years, 11% of divers having less than one year's experience. Sixty-seven per cent had worked at a maximum depth of 200 ft (61 m) and only 6% had worked deeper than 500 ft (153 m). The mean forced vital capacity (FVC) was 120-4% of the predicted value which indicated that they could voluntarily move large amounts of gas in and out of their lungs. This was greatest in the divers who when deepest. The mean forced expired volume in one second (FEV 1) was 117% of the predicted value showing that expiratory airflow capacity was also increased, but to a lesser extent than the FVC. Thper and activated by zinc. Plasma protein protected the enzyme from both inhibition and activation. ALAD activity was found to be an indicator of the total metal ion concentration in the blood and was therfore considered to be of doubtful value in screening large population for increased lead absorption.