Regulating the ventilatory pump: a splendid control system prone to fail during sleep

Mechanical properties of the upper airway

The importance of the upper airway (nose, pharynx, and larynx) in health and in the pathogenesis of sleep apnea, asthma, and other airway diseases, discussed elsewhere in the Comprehensive Physiology series, prompts this review of the biomechanical properties and functional aspects of the upper airway. There is a literature based on anatomic or structural descriptions in static circumstances, albeit studied in limited numbers of individuals in both health and disease. As for dynamic features, the literature is limited to studies of pressure and flow through all or parts of the upper airway and to the effects of muscle activation on such features; however, the links between structure and function through airway size, shape, and compliance remain a topic that is completely open for investigation, particularly through analyses using concepts of fluid and structural mechanics. Throughout are included both historically seminal references, as well as those serving as signposts or updated reviews. This article should be considered a resource for concepts needed for the application of biomechanical models of upper airway physiology, applicable to understanding the pathophysiology of disease and anticipated results of treatment interventions.

Chemoreceptor plasticity and respiratory acclimation in the zebrafishDanio rerio

The goals of this study were to assess the respiratory consequences of exposing adult zebrafish Danio rerio to chronic changes in water gas composition (hypoxia, hyperoxia or hypercapnia) and to determine if any ensuing effects could be related to morphological changes in branchial chemoreceptors. To accomplish these goals, we first modified and validated an established non-invasive technique for continuous monitoring of breathing frequency and relative breathing amplitude in adult fish. Under normal conditions 20% of zebrafish exhibited an episodic breathing pattern that was composed of breathing and non-breathing (pausing/apneic) periods. The pausing frequency was reduced by acute hypoxia (PwO2<130 mmHg)and increased by acute hyperoxia (PwO2>300 mmHg), but was unaltered by acute hypercapnia.

Fish were exposed for 28 days to hyperoxia (PwO2>350 mmHg), or hypoxia (PwO2=30 mmHg) or hypercapnia(PwCO2=9 mmHg). Their responses to acute hypoxia or hypercapnia were then compared to the response of control fish kept for 28 days in normoxic and normocapnic water. In control fish, the ventilatory response to acute hypoxia consisted of an increase in breathing frequency while the response to acute hypercapnia was an increase in relative breathing amplitude. The stimulus promoting the hyperventilation during hypercapnia was increased PwCO2 rather than decreased pH. Exposure to prolonged hyperoxia decreased the capacity of fish to increase breathing frequency during hypoxia and prevented the usual increase in breathing amplitude during acute hypercapnia. In fish previously exposed to hyperoxia,episodic breathing continued during acute hypoxia until PwO2 had fallen below 70 mmHg. In fish chronically exposed to hypoxia, resting breathing frequency was significantly reduced (from 191±12 to 165±16 min–1); however, the ventilatory responses to hypoxia and hypercapnia were unaffected. Long-term exposure of fish to hypercapnic water did not markedly modify the breathing response to acute hypoxia and modestly blunted the response to hypercapnia.

To determine whether branchial chemoreceptors were being influenced by long-term acclimation, all four groups of fish were acutely exposed to increasing doses of the O2 chemoreceptor stimulant, sodium cyanide,dissolved in inspired water. Consistent with the blunting of the ventilatory response to hypoxia, the fish pre-exposed to hyperoxia also exhibited a blunted response to NaCN. Pre-exposure to hypoxia was without effect whereas prior exposure to hypercapnia increased the ventilatory responses to cyanide.

To assess the impact of acclimation to varying gas levels on branchial O2 chemoreceptors, the numbers of neuroepithelial cells (NECs) of the gill filament were quantified using confocal immunofluorescence microscopy. Consistent with the blunting of reflex ventilatory responses, fish exposed to chronic hyperoxia exhibited a significant decrease in the density of NECs from 36.8±2.8 to 22.7±2.3 filament–1.

Human G protein beta3 subunit variant does not alter hypercarbic or hypoxic ventilatory response

Hypercarbic respiratory drive is mainly determined by PCO(2) and pH with activity of the intracellular Na+/H+ exchanger (NHE) playing an important role in maintaining intracellular pH and respiratory drive. Because NHE activity varies with genetically different G-protein beta3 subunits (GNB3) (C/T polymorphism at nucleotide position 825) different genotypes might alter respiratory regulation. To test the hypothesis that short-term ventilatory responses vary with different GNB3 healthy volunteers with different genotypes (CC, TC, TT) were exposed to either hyperoxic hypercarbia (n=33) or to isocapnic hypoxia (n=31), respectively. There was no difference between CC, TC, and TT genotypes in hypercarbic and hypoxic respiratory drive when assessed as the ratio of minute ventilation over endexpiratory PCO(2) changes (DeltaV.E/DeltaPETCO(2)), maximal tolerable PETCO(2), and ratio of changes in ventilation over arterial haemoglobin desaturation (DeltaV.E/DeltaSO(2)), respectively. Thus, short-term hypercarbic and hypoxic ventilatory drive do not differ between individuals with genotypes encoding different GNB3. Whilst respiratory control may still be influenced by G-protein aberration, other mechanisms seem to have a more important role in controlling ventilation.

Breath-to-breath variability correlates with apnea-hypopnea index in obstructive sleep apnea

BACKGROUND

Breathing in patients with obstructive sleep apnea (OSA) is frequently interrupted by periods of hypopnea and apnea. There is limited information regarding a possible disturbance of breathing outside these periods.

STUDY OBJECTIVE

To analyze the degree of breathing disturbance during nonocclusion.

DESIGN

Prospective determination of breathing variability during full polysomnographic sleep studies.

PATIENTS

Breath-to-breath variation was monitored in 34 patients with OSA and in 9 healthy subjects.

MEASUREMENTS AND RESULTS

All breath-to-breath intervals were automatically analyzed from flow signal, displayed, and manually corrected for artifacts. Distribution of all nonapneic breath intervals was analyzed for the extent of difference from a normal distribution pattern by specifying kurtosis. In untreated OSA patients, kurtosis was significantly reduced (0.0 +/- 0.5, mean +/- SD) compared to control subjects (0.8 +/- 0.5), indicating increased variability of nonoccluded breathing. This effect was present in all sleep stages, and the extent depended significantly on the degree of disease. Continuous positive airway pressure breathing was able to normalize kurtosis (1.0 +/- 0.9) immediately.

CONCLUSIONS

Breathing in OSA is not only characterized by interruptions of breathing during occlusion, but by a greater variation in the pattern of normal-length breaths.

Neuroepithelial bodies as airway oxygen sensors

Since the discovery of neuroepithelial bodies (NEB) in the late 1930s, evidence has accumulated to suggest that these cells may function as hypoxia-sensitive airway sensors. Until recently, this hypothesis was based largely on morphological observations. The use of in vitro models of isolated NEB, combined with electrophysiological approaches, have provided direct evidence that NEB cells express a membrane-bound O2 sensor and are the transducers of hypoxic stimulus. Here, we review the historical evidence and current state of knowledge of the oxygen-sensing properties of NEB cells, comparison with other O2 sensing cells, as well as recent advances that have been made using molecular and electrophysiological techniques. The possible role of NEB in perinatal pulmonary pathophysiology is also discussed.