1
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Valentin R, Niérat M, Wattiez N, Jacq O, Decavèle M, Arnulf I, Similowski T, Attali V. Neurophysiological basis of respiratory discomfort improvement by mandibular advancement in awake OSA patients. Physiol Rep 2024; 12:e15951. [PMID: 38373738 PMCID: PMC10984610 DOI: 10.14814/phy2.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Patients with obstructive sleep apneas (OSA) do not complain from dyspnea during resting breathing. Placement of a mandibular advancement device (MAD) can lead to a sense of improved respiratory comfort ("pseudo-relief") ascribed to a habituation phenomenon. To substantiate this conjecture, we hypothesized that, in non-dyspneic awake OSA patients, respiratory-related electroencephalographic figures, abnormally present during awake resting breathing, would disappear or change in parallel with MAD-associated pseudo-relief. In 20 patients, we compared natural breathing and breathing with MAD on: breathing discomfort (transitional visual analog scale, VAS-2); upper airway mechanics, assessed in terms of pressure peak/time to peak (TTP) ratio respiratory-related electroencephalography (EEG) signatures, including slow event-related preinspiratory potentials; and a between-state discrimination based on continuous connectivity evaluation. MAD improved breathing and upper airway mechanics. The 8 patients in whom the EEG between-state discrimination was considered effective exhibited higher Peak/TTP improvement and transitional VAS ratings while wearing MAD than the 12 patients where it was not. These results support the notion of habituation to abnormal respiratory-related afferents in OSA patients and fuel the causative nature of the relationship between dyspnea, respiratory-related motor cortical activity and impaired upper airway mechanics in this setting.
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Affiliation(s)
- Rémi Valentin
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
| | - Marie‐Cécile Niérat
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Nicolas Wattiez
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Olivier Jacq
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Maxens Decavèle
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Service de Médecine Intensive et Réanimation (Département R3S)Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
| | - Isabelle Arnulf
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Paris Brain Institute (ICM)Sorbonne UniversitéParisFrance
| | - Thomas Similowski
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital, Pitié‐Salpêtrière, Département R3SAP‐HP, Groupe Hospitalier APHP‐Sorbonne UniversitéParisFrance
| | - Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
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2
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Taytard J, Niérat MC, Gand C, Lavault S, Morélot-Panzini C, Patout M, Serresse L, Wattiez N, Bodineau L, Straus C, Similowski T. Short-term cognitive loading deteriorates breathing pattern and gas exchange in adult patients with congenital central hypoventilation syndrome. ERJ Open Res 2023; 9:00408-2022. [PMID: 36923564 PMCID: PMC10009700 DOI: 10.1183/23120541.00408-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/05/2022] [Indexed: 11/12/2022] Open
Abstract
Question Human PHOX2B mutations result in life-threatening sleep-related hypoventilation (congenital central hypoventilation syndrome, CCHS). Most patients retain ventilatory activity when awake through a respiratory-related cortical network. We hypothesised that this need to mobilise cortical resources to breathe would lead to breathing-cognition interferences during cognitive loading. Patients and methods Seven adult CCHS patients (five women; median age 21) performed standard neuropsychological tests (paced auditory serial addition test - calculation capacity, working memory, sustained and divided attention; trail making test - visuospatial exploration capacity, cognitive processing speed, attentional flexibility; Corsi block-tapping test - visuospatial memory, short-term memory, working memory) during unassisted breathing and under ventilatory support. Ventilatory variables and transcutaneous haemoglobin oxygen saturation were recorded. Cortical connectivity changes between unassisted breathing and ventilatory support were assessed using electroencephalographic recordings (EEG). Results Baseline performances were lower than expected in individuals of this age. During unassisted breathing, cognitive loading coincided with increased breathing variability, and decreases in oxygen saturation inversely correlated with an increasing number of apnoeic cycles per minute (rho -0.46, 95% CI -0.76 to -0.06, p=0.01). During ventilatory support, cognitive tasks did not disrupt breathing pattern and were not associated with decreased oxygen saturation. Ventilatory support was associated with changes in EEG cortical connectivity but not with improved test performances. Conclusions Acute cognitive loads induce oxygen desaturation in adult CCHS patients during unassisted breathing, but not under ventilatory support. This justifies considering the use of ventilatory support during mental tasks in CCHS patients to avoid repeated episodes of hypoxia.
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Affiliation(s)
- Jessica Taytard
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Armand-Trousseau, Service de Pneumologie Pédiatrique, Paris, France
| | - Marie-Cécile Niérat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Camille Gand
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sophie Lavault
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
| | - Capucine Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
| | - Maxime Patout
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Centre de référence maladie rare "hypoventilations centrales congénitales" (Département R3S), Paris, France
| | - Laure Serresse
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Nicolas Wattiez
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Laurence Bodineau
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Christian Straus
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service d'Exploration Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France.,These authors contributed equally
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France.,These authors contributed equally
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3
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Betka S, Adler D, Similowski T, Blanke O. Breathing control, brain, and bodily self-consciousness: Toward immersive digiceuticals to alleviate respiratory suffering. Biol Psychol 2022; 171:108329. [PMID: 35452780 DOI: 10.1016/j.biopsycho.2022.108329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Abstract
Breathing is peculiar among autonomic functions through several characteristics. It generates a very rich afferent traffic from an array of structures belonging to the respiratory system to various areas of the brain. It is intimately associated with bodily movements. It bears particular relationships with consciousness as its efferent motor control can be automatic or voluntary. In this review within the scope of "respiratory neurophysiology" or "respiratory neuroscience", we describe the physiological organisation of breathing control. We then review findings linking breathing and bodily self-consciousness through respiratory manipulations using virtual reality (VR). After discussing the currently admitted neurophysiological model for dyspnea, as well as a new Bayesian model applied to breathing control, we propose that visuo-respiratory paradigms -as developed in cognitive neuroscience- will foster insights into some of the basic mechanisms of the human respiratory system and will also lead to the development of immersive VR-based digital health tools (i.e. digiceuticals).
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Affiliation(s)
- Sophie Betka
- Laboratory of Cognitive Neuroscience, Brain Mind Institute and Center for Neuroprosthetics, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, (EPFL), Geneva 1202, Switzerland.
| | - Dan Adler
- Division of Lung Diseases, University Hospital and Geneva Medical School, University of Geneva, Switzerland
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S (Respiration, Réanimation, Réhabilitation respiratoire, Sommeil), F-75013 Paris, France
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain Mind Institute and Center for Neuroprosthetics, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, (EPFL), Geneva 1202, Switzerland; Department of Clinical Neurosciences, University Hospital and Geneva Medical School, University of Geneva, Switzerland
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4
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Taytard J, Gand C, Niérat MC, Barthes R, Lavault S, Adler D, Morélot Panzini C, Gatignol P, Campion S, Serresse L, Wattiez N, Straus C, Similowski T. Impact of inspiratory threshold loading on brain activity and cognitive performances in healthy humans. J Appl Physiol (1985) 2021; 132:95-105. [PMID: 34818073 DOI: 10.1152/japplphysiol.00994.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In healthy humans, inspiratory threshold loading deteriorates cognitive performances. This can result from motor-cognitive interference (activation of motor respiratory-related cortical networks vs. executive resources allocation), sensory-cognitive interference (dyspnea vs. shift in attentional focus), or both. We hypothesized that inspiratory loading would concomitantly induce dyspnea, activate motor respiratory-related cortical networks, and deteriorate cognitive performance. We reasoned that a concomitant activation of cortical networks and cognitive deterioration would be compatible with motor-cognitive interference, particularly in case of a predominant alteration of executive cognitive performances. Symmetrically, we reasoned that a predominant alteration of attention-depending performances would suggest sensory-cognitive interference. Twenty-five volunteers (12 men; 19.5-51.5 years) performed the Paced Auditory Serial Addition test (PASAT-A and B; calculation capacity, working memory, attention), the Trail Making Test (TMT-A, visuospatial exploration capacity; TMT-B, visuospatial exploration capacity and attention), and the Corsi block-tapping test (visuospatial memory, short-term and working memory) during unloaded breathing and inspiratory threshold loading in random order. Loading consistently induced dyspnea and respiratory-related brain activation. It was associated with deteriorations inPASAT A (52 [45.5;55.5] (median [interquartile range]) to 48 [41;54.5], p=0.01), PASAT B (55 [47.5;58] to 51 [44.5;57.5], p=0.01), and TMT B (44s [36;54.5] to 53s [42;64], p=0.01), but did not affect TMT-A and Corsi. The concomitance of cortical activation and cognitive performance deterioration is compatible with competition for cortical resources (motor-cognitive interference), while the profile of cognitive impairment (PASAT and TMT-B but not TMT-A and Corsi) is compatible with a contribution of attentional distraction (sensory-cognitive interference). Both mechanisms are therefore likely at play.
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Affiliation(s)
- Jessica Taytard
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Armand-Trousseau, Service de Pneumologie Pédiatrique, F-75012 Paris, France
| | - Camille Gand
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Marie-Cécile Niérat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Romain Barthes
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sophie Lavault
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France
| | - Dan Adler
- Division of Pulmonary Disease, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Capucine Morélot Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France
| | - Peggy Gatignol
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service d'ORL et d'oto-neurochirurgie, Paris, France
| | - Sebastien Campion
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, Paris, France
| | - Laure Serresse
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Unité Mobile de Soins Palliatifs, Paris, France
| | - Nicolas Wattiez
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Christian Straus
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié31 Salpêtrière, Service d'Exploration Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France
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5
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Lim W, Breitling M, Nugent B, Sinha A, Diaz K. A Case of Medullary Infarct Causing Central Alveolar Hypoventilation. Cureus 2021; 13:e17153. [PMID: 34548970 PMCID: PMC8437087 DOI: 10.7759/cureus.17153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/05/2022] Open
Abstract
Central alveolar hypoventilation (CAH) is a rarely encountered pathology characterized by decreased ventilation due to the loss of autonomic control. Most cases present at birth, as it can be a rare genetic disorder, but we aim to show that it can occur as an acquired condition too. We present a case of a 65-year-old man who developed CAH as a sequela of an ischemic stroke and discuss possible pathophysiology. Increasing awareness and an early detection of this condition can have a significant effect on morbidity and mortality of patients.
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Affiliation(s)
- William Lim
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - May Breitling
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Bryan Nugent
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Aditi Sinha
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Keith Diaz
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
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6
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Adult-onset congenital central hypoventilation syndrome due to PHOX2B mutation. Acta Neurol Belg 2021; 121:23-35. [PMID: 32335870 DOI: 10.1007/s13760-020-01363-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 01/29/2023]
Abstract
Central hypoventilation in adult patients is a rare life-threatening condition characterised by the loss of automatic breathing, more pronounced during sleep. In most cases, it is secondary to a brainstem lesion or to a primary pulmonary, cardiac or neuromuscular disease. More rarely, it can be a manifestation of congenital central hypoventilation syndrome (CCHS). We here describe a 25-year-old woman with severe central hypoventilation triggered by analgesics. Genetic analysis confirmed the diagnosis of adult-onset CCHS caused by a heterozygous de novo poly-alanine repeat expansion of the PHOX2B gene. She was treated with nocturnal non-invasive ventilation. We reviewed the literature and found 21 genetically confirmed adult-onset CCHS cases. Because of the risk of deleterious respiratory complications, adult-onset CCHS is an important differential diagnosis in patients with central hypoventilation.
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7
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Di Lascio S, Benfante R, Cardani S, Fornasari D. Research Advances on Therapeutic Approaches to Congenital Central Hypoventilation Syndrome (CCHS). Front Neurosci 2021; 14:615666. [PMID: 33510615 PMCID: PMC7835644 DOI: 10.3389/fnins.2020.615666] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/17/2020] [Indexed: 12/11/2022] Open
Abstract
Congenital central hypoventilation syndrome (CCHS) is a genetic disorder of neurodevelopment, with an autosomal dominant transmission, caused by heterozygous mutations in the PHOX2B gene. CCHS is a rare disorder characterized by hypoventilation due to the failure of autonomic control of breathing. Until now no curative treatment has been found. PHOX2B is a transcription factor that plays a crucial role in the development (and maintenance) of the autonomic nervous system, and in particular the neuronal structures involved in respiratory reflexes. The underlying pathogenetic mechanism is still unclear, although studies in vivo and in CCHS patients indicate that some neuronal structures may be damaged. Moreover, in vitro experimental data suggest that transcriptional dysregulation and protein misfolding may be key pathogenic mechanisms. This review summarizes latest researches that improved the comprehension of the molecular pathogenetic mechanisms responsible for CCHS and discusses the search for therapeutic intervention in light of the current knowledge about PHOX2B function.
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Affiliation(s)
- Simona Di Lascio
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Roberta Benfante
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy.,CNR-Institute of Neuroscience, Milan, Italy.,NeuroMi-Milan Center for Neuroscience, University of Milano Bicocca, Milan, Italy
| | - Silvia Cardani
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Diego Fornasari
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy.,CNR-Institute of Neuroscience, Milan, Italy
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8
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Attali V, Lavault S, Guerder A, Al-Youssef S, Dudoignon B, Taytard J, Arnulf I, Faure M, Straus C, Similowski T. Awakening efficacy of a vibrotactile device in patients on home nocturnal ventilatory assistance and healthy subjects as family caregiver proxies. Chron Respir Dis 2020; 17:1479973120983331. [PMID: 33371725 PMCID: PMC7783873 DOI: 10.1177/1479973120983331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this study was to test the capacity of vibrotactile stimulation
transmitted to the wrist bones by a vibrating wristband to awaken healthy
individuals and patients requiring home mechanical ventilation during sleep.
Healthy subjects (n = 20) and patients with central hypoventilation (CH)
(Congenital Central Hypoventilation syndrome n = 7; non-genetic form of CH n =
1) or chronic obstructive pulmonary disease (COPD) (n = 9), underwent a
full-night polysomnography while wearing the wristband. Vibrotactile alarms were
triggered five times during the night at random intervals.
Electroencephalographic (EEG), clinical (trunk lift) and cognitive (record the
time on a sheet of paper) arousals were recorded. Cognitive arousals were
observed for 94% of the alarms in the healthy group and for 66% and 63% of
subjects in the CH and COPD groups, respectively (p < 0.01). The percentage
of participants experiencing cognitive arousals for all alarms, was 72% for
healthy subjects, 37.5% for CH patients and 33% for COPD patients (ns) (94%, 50%
and 44% for clinical arousals (p < 0.01) and 100%, 63% and 44% for EEG
arousals (p < 0.01)). Device acceptance was good in the majority of cases,
with the exception of one CH patient and eight healthy participants. In summary
this study shows that a vibrotactile stimulus is effective to induce awakenings
in healthy subjects, but is less effective in patients, supporting the notion
that a vibrotactile stimulus could be an effective backup to a home mechanical
ventilator audio alarm for healthy family caregivers.
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Affiliation(s)
- Valerie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service des Pathologies du Sommeil, Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3 S, Centre de référence Constitutif « maladies rares » pour le Syndrome d'Ondine (adultes), Paris, France
| | - Sophie Lavault
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3 S, Centre de référence Constitutif « maladies rares » pour le Syndrome d'Ondine (adultes), Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service de Pneumologie, Médecine Intensive et Réanimation, Paris, France
| | - Antoine Guerder
- 26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service de Pneumologie, Médecine Intensive et Réanimation, Paris, France
| | - Saba Al-Youssef
- 26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service des Pathologies du Sommeil, Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3 S, Centre de référence Constitutif « maladies rares » pour le Syndrome d'Ondine (adultes), Paris, France
| | - Benjamin Dudoignon
- 26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service des Pathologies du Sommeil, Paris, France
| | - Jessica Taytard
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Trousseau, Service de Pneumologie Pédiatrique, Paris, France
| | - Isabelle Arnulf
- 26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service des Pathologies du Sommeil, Paris, France
| | - Morgane Faure
- 26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service de Pneumologie, Médecine Intensive et Réanimation, Paris, France
| | - Christian Straus
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3 S, Centre de référence Constitutif « maladies rares » pour le Syndrome d'Ondine (adultes), Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3 S, Centre de référence Constitutif « maladies rares » pour le Syndrome d'Ondine (adultes), Paris, France.,26930AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service de Pneumologie, Médecine Intensive et Réanimation, Paris, France
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Laghi F, Shaikh H, Littleton SW, Morales D, Jubran A, Tobin MJ. Inhibition of central activation of the diaphragm: a mechanism of weaning failure. J Appl Physiol (1985) 2020; 129:366-376. [PMID: 32673161 PMCID: PMC7473953 DOI: 10.1152/japplphysiol.00856.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During a T-tube trial following disconnection of mechanical ventilation, patients failing the trial do not develop contractile diaphragmatic fatigue despite increases in inspiratory pressure output. Studies in volunteers, patients, and animals raise the possibility of spinal and supraspinal reflex mechanisms that inhibit central-neural output under loaded conditions. We hypothesized that diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. Tidal transdiaphragmatic pressure (ΔPdi) and electrical activity (ΔEAdi) were recorded with esophago-gastric catheters during a T-tube trial in 20 critically ill patients. During the T-tube trial, ∆EAdi was greater in weaning failure patients than in weaning success patients (P = 0.049). Despite increases in ΔPdi, from 18.1 ± 2.5 to 25.9 ± 3.7 cm H2O (P < 0.001), rate of transdiaphragmatic pressure development (from 22.6 ± 3.1 to 37.8 ± 6.7 cm H2O/s; P < 0.0004), and concurrent respiratory distress, ∆EAdi at the end of a failed T-tube trial was half of maximum, signifying inhibition of central neural output to the diaphragm. The increase in ΔPdi in the weaning failure group, while ∆EAdi remained constant, indicates unexpected improvement in diaphragmatic neuromuscular coupling (from 46.7 ± 6.5 to 57.8 ± 8.4 cm H2O/%; P = 0.006). Redistribution of neural output to the respiratory muscles characterized by a progressive increase in rib cage and accessory muscle contribution to tidal breathing and expiratory muscle recruitment contributed to enhanced coupling. In conclusion, diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. This finding signifies that reflex inhibition of central neural output to the diaphragm contributes to weaning failure. NEW & NOTEWORTHY Research into pathophysiology of failure to wean from mechanical ventilation has excluded several factors, including contractile fatigue, but the precise mechanism remains unknown. We recorded transdiaphragmatic pressure and diaphragmatic electrical activity in patients undergoing a T-tube trial. Diaphragmatic recruitment was submaximal at the end of a failed trial despite concurrent respiratory distress, signifying that inhibition of central neural output to the diaphragm is an important mechanism of weaning failure.
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Affiliation(s)
- Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Stephen W Littleton
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Daniel Morales
- Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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10
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Nguyen DAT, Boswell-Ruys CL, McCaughey EJ, Gandevia SC, Hudson AL, Butler JE. Absence of inspiratory premotor potentials during quiet breathing in cervical spinal cord injury. J Appl Physiol (1985) 2020; 128:660-666. [PMID: 32078470 DOI: 10.1152/japplphysiol.00831.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A premotor potential, or Bereitschaftspotential (BP), is a low-amplitude negativity in the electroencephalographic activity (EEG) of the sensorimotor cortex. It begins ~1 s prior to the onset of inspiration in the averaged EEG. Although normally absent during quiet breathing in healthy, younger people, inspiration-related BPs are present in people with respiratory disease and healthy, older people, indicating a cortical contribution to quiet breathing. People with tetraplegia have weak respiratory muscles and increased neural drive during quiet breathing, indicated by increased inspiratory muscle activity. Therefore, we hypothesized that BPs would be present during quiet breathing in people with tetraplegia. EEG was recorded in 17 people with chronic tetraplegia (14M, 3 female; 22-51 yr; C3-C7, American Spinal Injury Association Impairment Scale A-D; >1 yr postinjury). They had reduced lung function and respiratory muscle weakness [FEV1: 54 ± 19% predicted, FVC: 59 ± 22% predicted and MIP: 56 ± 24% predicted (mean ± SD)]. Participants performed quiet breathing and voluntary self-paced sniffs (positive control condition). A minimum of 250 EEG epochs during quiet breathing and 60 epochs during sniffs, time-locked to the onset of inspiration, were averaged to determine the presence of BPs at Cz, FCz, C3, and C4. Fifteen participants (88%) had a BP for the sniffs. Of these 15 participants, only one (7%) had a BP in quiet breathing, a rate similar to that reported during quiet breathing in young able-bodied participants (12%). The findings suggest that, as in young able-bodied people, a cortical contribution to quiet breathing is absent in people with tetraplegia despite higher neural drive.NEW & NOTEWORTHY People with tetraplegia have weak respiratory muscles, increased neural drive during quiet breathing, and a high incidence of sleep-disordered breathing. Using electroencephalographic recordings, we show that inspiratory premotor potentials are absent in people with chronic tetraplegia during quiet breathing. This suggests that cortical activity is not present during resting ventilation in people with tetraplegia who are awake and breathing independently.
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Affiliation(s)
- David A T Nguyen
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Euan James McCaughey
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
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11
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Azabou E, Bao G, Heming N, Bounab R, Moine P, Chevallier S, Chevret S, Resche-Rigon M, Siami S, Sharshar T, Lofaso F, Annane D. Randomized Controlled Study Evaluating Efficiency of Low Intensity Transcranial Direct Current Stimulation (tDCS) for Dyspnea Relief in Mechanically Ventilated COVID-19 Patients in ICU: The tDCS-DYSP-COVID Protocol. Front Med (Lausanne) 2020; 7:372. [PMID: 32671084 PMCID: PMC7332773 DOI: 10.3389/fmed.2020.00372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
The severe respiratory distress syndrome linked to the new coronavirus disease (COVID-19) includes unbearable dyspneic suffering which contributes to the deterioration of the prognosis of patients in intensive care unit (ICU). Patients are put on mechanical ventilation to reduce respiratory suffering and preserve life. Despite this mechanical ventilation, most patients continue to suffer from dyspnea. Dyspnea is a major source of suffering in intensive care and one of the main factors that affect the prognosis of patients. The development of innovative methods for its management, especially non-drug management is more than necessary. In recent years, numerous studies have shown that transcranial direct current stimulation (tDCS) could modulate the perception of acute or chronic pain. In the other hand, it has been shown that the brain zones activated during pain and dyspnea are close and/or superimposed, suggesting that brain structures involved in the integration of aversive emotional component are shared by these two complex sensory experiences. Therefore, it can be hypothesized that stimulation by tDCS with regard to the areas which, in the case of pain have activated one or more of these brain structures, may also have an effect on dyspnea. In addition, our team recently demonstrated that the application of tDCS on the primary cortical motor area can modulate the excitability of the respiratory neurological pathways. Indeed, tDCS in anodal or cathodal modality reduced the excitability of the diaphragmatic cortico-spinal pathways in healthy subjects. We therefore hypothesized that tDCS could relieve dyspnea in COVID-19 patients under mechanical ventilation in ICU. This study was designed to evaluate effects of two modalities of tDCS (anodal and cathodal) vs. placebo, on the relief of dyspnea in COVID-19 patients requiring mechanical ventilation in ICU. Trial Registration: This protocol is derived from the tDCS-DYSP-REA project registered on ClinicalTrials.gov NCT03640455. It will however be registered under its own NCT number.
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Affiliation(s)
- Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
- *Correspondence: Eric Azabou ;
| | - Guillaume Bao
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Nicholas Heming
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Rania Bounab
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Pierre Moine
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Sylvain Chevallier
- Versailles Engineering Systems Laboratory (LISV), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Velizy, France
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint Louis, Paris, France
- Inserm U1153 CRESS, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France
- Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France
| | - Matthieu Resche-Rigon
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint Louis, Paris, France
- Inserm U1153 CRESS, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France
- Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France
| | - Shidaps Siami
- Critical Care Medicine Unit, CH Etampes-Dourdan, Etampes, France
| | - Tarek Sharshar
- Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
- Laboratory of Human Histopathology and Animal Models, Institut Pasteur, Paris, France
| | - Frederic Lofaso
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Djillali Annane
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
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Raux M, Navarro-Sune X, Wattiez N, Kindler F, Le Corre M, Decavele M, Demiri S, Demoule A, Chavez M, Similowski T. Adjusting ventilator settings to relieve dyspnoea modifies brain activity in critically ill patients: an electroencephalogram pilot study. Sci Rep 2019; 9:16572. [PMID: 31719608 PMCID: PMC6851109 DOI: 10.1038/s41598-019-53152-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
Dyspnoea is frequent and distressing in patients receiving mechanical ventilation, but it is often not properly evaluated by caregivers. Electroencephalographic signatures of dyspnoea have been identified experimentally in healthy subjects. We hypothesized that adjusting ventilator settings to relieve dyspnoea in MV patients would induce EEG changes. This was a first-of-its-kind observational study in a convenience population of 12 dyspnoeic, mechanically ventilated patients for whom a decision to adjust the ventilator settings was taken by the physician in charge (adjustments of pressure support, slope, or trigger). Pre- and post-ventilator adjustment electroencephalogram recordings were processed using covariance matrix statistical classifiers and pre-inspiratory potentials. The pre-ventilator adjustment median dyspnoea visual analogue scale was 3.0 (interquartile range: 2.5–4.0; minimum-maximum: 1–5) and decreased by (median) 3.0 post-ventilator adjustment. Statistical classifiers adequately detected electroencephalographic changes in 8 cases (area under the curve ≥0.7). Previously present pre-inspiratory potentials disappeared in 7 cases post-ventilator adjustment. Dyspnoea improvement was consistent with electroencephalographic changes in 9 cases. Adjusting ventilator settings to relieve dyspnoea produced detectable changes in brain activity. This paves the way for studies aimed at determining whether monitoring respiratory-related electroencephalographic activity can improve outcomes in critically ill patients under mechanical ventilation.
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Affiliation(s)
- Mathieu Raux
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Département d'Anesthésie-Réanimation, F-75013, Paris, France
| | - Xavier Navarro-Sune
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,Sorbonne Université, INSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Nicolas Wattiez
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France
| | - Felix Kindler
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France
| | - Marine Le Corre
- AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Département d'Anesthésie-Réanimation, F-75013, Paris, France
| | - Maxens Decavele
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France
| | - Suela Demiri
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France
| | - Mario Chavez
- Sorbonne Université, INSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France.
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13
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Optogenetic analysis of respiratory neuronal networks in the ventral medulla of neonatal rats producing channelrhodopsin in Phox2b-positive cells. Pflugers Arch 2019; 471:1419-1439. [DOI: 10.1007/s00424-019-02317-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/06/2019] [Accepted: 10/04/2019] [Indexed: 12/19/2022]
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14
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Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dubé BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich R, Rossi A, Series F, Similowski T, Spengler C, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53:13993003.01214-2018. [DOI: 10.1183/13993003.01214-2018] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.
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15
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Launois C, Perger E, Attali V, Nierat M, Raux M, Arnulf I, Similowski T, Redolfi S. Postural respiratory‐related cortical activation and rostral fluid shift in awake healthy humans. Exp Physiol 2019; 104:887-895. [DOI: 10.1113/ep087468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Elisa Perger
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et RéanimationDépartement R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
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16
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Morélot‐Panzini C. Respiratory‐related cortical activity in patients with COPD and aged normal individuals: towards a different vision of dyspnoea? J Physiol 2018; 596:6137-6138. [DOI: 10.1113/jp276761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Capucine Morélot‐Panzini
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et Réanimation, (Département “R3S”) F‐75013 Paris France
- Sorbonne UniversitéINSERM UMRS1158 Neurophysiologie respiratoire expérimentale et clinique F‐75005 Paris France
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17
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Nierat MC, Raux M, Redolfi S, Gonzalez-Bermejo J, Biondi G, Straus C, Rivals I, Morélot-Panzini C, Similowski T. Neuroergonomic and psychometric evaluation of full-face crew oxygen masks respiratory tolerance: a proof-of-concept study. J ROY ARMY MED CORPS 2018; 165:317-324. [PMID: 30415218 DOI: 10.1136/jramc-2018-001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Preventing in-flight hypoxia in pilots is typically achieved by wearing oxygen masks. These masks must be as comfortable as possible to allow prolonged and repeated use. The consequences of mask-induced facial contact pressure have been extensively studied, but little is known about mask-induced breathing discomfort. Because breathlessness is a strong distractor and engages cerebral resources, it could negatively impact flying performances. METHODS Seventeen volunteers (age 20-32) rated respiratory discomfort while breathing with no mask and with two models of quick-donning full-face crew oxygen masks with regulators (mask A, mask B). Electroencephalographic recordings were performed to detect a putative respiratory-related cortical activation in response to inspiratory constraint (experiment 1, n=10). Oxygen consumption was measured using indirect calorimetry (experiment 2, n=10). RESULTS With mask B, mild respiratory discomfort was reported significantly more frequently than with no mask or mask A (experiment 1: median respiratory discomfort on visual analogue scale 0.9 cm (0.5-1.4), experiment 1; experiment 2: 2 cm (1.7-2.9)). Respiratory-related cortical activation was present in 1/10 subjects with no mask, 1/10 with mask A and 6/10 with mask B (significantly more frequently with mask B). Breathing pattern, sigh frequency and oxygen consumption were not different. CONCLUSIONS In a laboratory setting, breathing through high-end aeronautical full-face crew oxygen masks can induce mild breathing discomfort and activate respiratory-related cortical networks. Whether or not this can occur in real-life conditions and have operational consequences remains to be investigated. Meanwhile, respiratory psychometric and neuroergonomic approaches could be worth integrating to masks development and evaluation processes.
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Affiliation(s)
- Marie-Cécile Nierat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - M Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département d'Anesthésie-Réanimation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - S Redolfi
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service des Pathologies du Sommeil, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - J Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - G Biondi
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - C Straus
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service des Explorations de la Fonction Respiratoire, de l'Exercice et de la Dyspnée, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - I Rivals
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - C Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - T Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France .,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
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Pouget P, Allard E, Poitou T, Raux M, Wattiez N, Similowski T. Slower Is Higher: Threshold Modulation of Cortical Activity in Voluntary Control of Breathing Initiation. Front Neurosci 2018; 12:663. [PMID: 30364283 PMCID: PMC6193114 DOI: 10.3389/fnins.2018.00663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022] Open
Abstract
Speech or programmed sentences must often be interrupted in order to listen to and interact with interlocutors. Among many processes that produce such complex acts, the brain must precisely adjust breathing to produce adequate phonation. The mechanism of these adjustments is multifactorial and still poorly understood. In order to selectively examine the adjustment in breath control, we recorded respiratory-related premotor cortical potentials from the scalp of human subjects while they performed a single breathing initiation or inhibition task. We found that voluntary breathing is initiated if, and only if, the cortical premotor potential activity reaches a threshold activation level. The stochastic variability in the threshold correlates to the distribution of initiation times of breathing. The data also fitted a computerized interactive race model. Modeling results confirm that this model is also as effective in respiratory modality, as it has been found to be for eye and hand movements. No modifications were required to account for respiratory cycle inhibition processes. In this overly simplified task, we showed a link between voluntary initiation and control of breathing and activity in a fronto-median region of the cerebral cortex. These results shed light on some of the physiological constraints involved in the complex mechanisms of respiration, phonation, and language.
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Affiliation(s)
- Pierre Pouget
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France
| | - Etienne Allard
- UMRS1158, INSERM, Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC - University Pierre and Marie Curie, Paris, France
| | - Tymothée Poitou
- UMRS1158, INSERM, Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC - University Pierre and Marie Curie, Paris, France
| | - Mathieu Raux
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France.,Service de Pneumologie et Réanimation Médicale (Département "R3S"), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Nicolas Wattiez
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France
| | - Thomas Similowski
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France.,Service de Pneumologie et Réanimation Médicale (Département "R3S"), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
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19
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Nguyen DAT, Boswell-Ruys CL, McBain RA, Eckert DJ, Gandevia SC, Butler JE, Hudson AL. Inspiratory pre-motor potentials during quiet breathing in ageing and chronic obstructive pulmonary disease. J Physiol 2018; 596:6173-6189. [PMID: 29971827 DOI: 10.1113/jp275764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS A cortical contribution to breathing, as indicated by a Bereitschaftspotential (BP) in averaged electroencephalographic signals, occurs in healthy individuals when external inspiratory loads are applied. Chronic obstructive pulmonary disease (COPD) is a condition where changes in the lung, chest wall and respiratory muscles produce an internal inspiratory load. These changes also occur in normal ageing, although to a lesser extent. In the present study, we determined whether BPs are present during quiet breathing and breathing with an external inspiratory load in COPD compared to age-matched and young healthy controls. We demonstrated that increased age, rather than COPD, is associated with a cortical contribution to quiet breathing. A cortical contribution to inspiratory loading is associated with more severe dyspnoea (i.e. the sensation of breathlessness). We propose that cortical mechanisms may be engaged to defend ventilation in ageing with dyspnoea as a consequence. ABSTRACT A cortical contribution to breathing is determined by the presence of a Bereitschaftspotential, a low amplitude negativity in the averaged electroencephalographic (EEG) signal, which begins ∼1 s before inspiration. It occurs in healthy individuals when external inspiratory loads to breathing are applied. In chronic obstructive pulmonary disease (COPD), changes in the lung, chest wall and respiratory muscles produce an internal inspiratory load. We hypothesized that there would be a cortical contribution to quiet breathing in COPD and that a cortical contribution to breathing with an inspiratory load would be linked to dyspnoea, a major symptom of COPD. EEG activity was analysed in 14 participants with COPD (aged 57-84 years), 16 healthy age-matched (57-87 years) and 15 young (18-26 years) controls during quiet breathing and inspiratory loading. The presence of Bereitschaftspotentials, from ensemble averages of EEG epochs at Cz and FCz, were assessed by blinded assessors. Dyspnoea was rated using the Borg scale. The incidence of a cortical contribution to quiet breathing was significantly greater in participants with COPD (6/14) compared to the young (0/15) (P = 0.004) but not the age-matched controls (6/16) (P = 0.765). A cortical contribution to inspiratory loading was associated with higher Borg ratings (P = 0.007), with no effect of group (P = 0.242). The data show that increased age, rather than COPD, is associated with a cortical contribution to quiet breathing. A cortical contribution to inspiratory loading is associated with more severe dyspnoea. We propose that cortical mechanisms may be engaged to defend ventilation with dyspnoea as a consequence.
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Affiliation(s)
- David A T Nguyen
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Rachel A McBain
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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20
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Hudson AL, Niérat MC, Raux M, Similowski T. The Relationship Between Respiratory-Related Premotor Potentials and Small Perturbations in Ventilation. Front Physiol 2018; 9:621. [PMID: 29899704 PMCID: PMC5988848 DOI: 10.3389/fphys.2018.00621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Respiratory-related premotor potentials from averaged electroencephalography (EEG) over the motor areas indicate cortical activation in healthy participants to maintain ventilation in the face of moderate inspiratory or expiratory loads. These experimental conditions are associated with respiratory discomfort, i.e., dyspnea. Premotor potentials are also observed in resting breathing in patients with reduced automatic respiratory drive or respiratory muscle strength due to respiratory or neurological disease, presumably in an attempt to maintain ventilation. The aim of this study was to determine if small voluntary increases in ventilation or smaller load-capacity imbalances, that generate an awareness of breathing but aren’t necessarily dyspneic, give rise to respiratory premotor potentials in healthy participants. In 15 healthy subjects, EEG was recorded during voluntary large breaths (∼3× tidal volume, that were interspersed with smaller non-voluntary breaths in the same trial; in 10 subjects) and breathing with a ‘low’ inspiratory threshold load (∼7 cmH2O; in 8 subjects). Averaged EEG signals at Cz and FCz were assessed for premotor potentials prior to inspiration. Premotor potential incidence in large breaths was 40%, similar to that in the smaller non-voluntary breaths in the same trial (20%; p > 0.05) and to that in a separate trial of resting breathing (0%; p > 0.05). The incidence of premotor potentials was 25% in the low load condition, similar to that in resting breathing (0%; p > 0.05). In contrast, voluntary sniffs were always associated with a higher incidence of premotor potentials (100%; p < 0.05). We have demonstrated that in contrast to respiratory and neurological disease, there is no significant cortical contribution to increase tidal volume or to maintain the load-capacity balance with a small inspiratory threshold load in healthy participants as detected using event-related potential methodology. A lack of cortical contribution during loading was associated with low ratings of respiratory discomfort and minimal changes in ventilation. These findings advance our understanding of the neural control of breathing in health and disease and how respiratory-related EEG may be used for medical technologies such as brain-computer interfaces.
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Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia and University of New South Wales, Sydney, NSW, Australia.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Marie-Cécile Niérat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie Réanimation, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France
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21
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Central Hypoventilation: A Rare Complication of Wallenberg Syndrome. Case Rep Neurol Med 2018; 2018:4894820. [PMID: 29755801 PMCID: PMC5884277 DOI: 10.1155/2018/4894820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/19/2018] [Indexed: 11/18/2022] Open
Abstract
Central alveolar hypoventilation disorders denote conditions resulting from underlying neurologic disorders affecting the sensors, the central controller, or the integration of those signals leading to insufficient ventilation and reduction in partial pressures of oxygen. We report a patient who presented with a left lateral medullary ischemic stroke after aneurysm repair who subsequently developed a rare complication of CAH. Increased awareness of this condition's clinical manifestations is crucial to make an accurate diagnosis and understand its complications and prognosis.
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22
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Vinckier F, Morélot-Panzini C, Similowski T. Dyspnoea modifies the recognition of fearful expressions by healthy humans. Eur Respir J 2018; 51:51/2/1702253. [DOI: 10.1183/13993003.02253-2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/19/2017] [Indexed: 11/05/2022]
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Congenital central hypoventilation syndrome: An overview of etiopathogenesis, associated pathologies, clinical presentation, and management. Auton Neurosci 2017; 210:1-9. [PMID: 29249648 DOI: 10.1016/j.autneu.2017.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 11/12/2017] [Indexed: 12/19/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS), known colloquially as Ondine's curse, is a rare disorder characterized by impaired autonomic control of breathing during sleep from the loss of vagal input and diminished sensitivity of CO2 receptors in the medulla. CCHS correlates to the malformation of the neural crest located in the brainstem; this consequently affects the loss of sensitivity of CO2 chemoreceptors, bringing about hypoventilation during sleep. The primary cause of CCHS is the mutation of the paired-like homeobox PHO2XB gene, found in 90% of the patients. This mutation not only affects breathing but also drives neurological abnormalities such as autonomic and neurocognitive dysfunction. Though typically congenital, there have been late-onset (i.e., acquired) cases reported. It is vital for physicians and clinicians to be able to diagnose CCHS due to its similar presentation to other syndromes and disorders, which may cause it to be misdiagnosed and may account for its deleterious effects. CCHS can lead to a constellation of symptoms, and consideration of diseases that present concomitantly with CCHS affords us a better understanding of the etiology of this illness. Although a rare syndrome, we aim to review the current literature to emphasize the pathogenesis, etiology, clinical presentation, symptoms, diagnosis, and current treatment methods of CCHS for clinicians to better identify and understand this condition.
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24
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Allard E, Canzoneri E, Adler D, Morélot-Panzini C, Bello-Ruiz J, Herbelin B, Blanke O, Similowski T. Interferences between breathing, experimental dyspnoea and bodily self-consciousness. Sci Rep 2017; 7:9990. [PMID: 28855723 PMCID: PMC5577140 DOI: 10.1038/s41598-017-11045-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/18/2017] [Indexed: 12/13/2022] Open
Abstract
Dyspnoea, a subjective experience of breathing discomfort, is a most distressing symptom. It implicates complex cortical networks that partially overlap with those underlying bodily self-consciousness, the experience that the body is one's own within a given location (self-identification and self-location, respectively). Breathing as an interoceptive signal contributes to bodily self-consciousness: we predicted that inducing experimental dyspnoea would modify or disrupt this contribution. We also predicted that manipulating bodily self-consciousness with respiratory-visual stimulation would possibly attenuate dyspnoea. Twenty-five healthy volunteers were exposed to synchronous and asynchronous respiratory-visual illumination of an avatar during normal breathing and mechanically loaded breathing that elicited dyspnoea. During normal breathing, synchronous respiratory-visual stimulation induced illusory self-identification with the avatar and an illusory location of the subjects' breathing towards the avatar. This did not occur when respiratory-visual stimulation was performed during dyspnoea-inducing loaded breathing. In this condition, the affective impact of dyspnoea was attenuated by respiratory-visual stimulation, particularly when asynchronous. This study replicates and reinforces previous studies about the integration of interoceptive and exteroceptive signals in the construction of bodily self-consciousness. It confirms the existence of interferences between experimental dyspnoea and cognitive functions. It suggests that respiratory-visual stimulation should be tested as a non-pharmacological approach of dyspnoea treatment.
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Affiliation(s)
- Etienne Allard
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Elisa Canzoneri
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013, Paris, France
| | - Javier Bello-Ruiz
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Bruno Herbelin
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.
- Division of Pulmonary Diseases, Geneva University Hospital, Geneva, Switzerland.
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25
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Neurophysiological Evidence for a Cortical Contribution to the Wakefulness-Related Drive to Breathe Explaining Hypocapnia-Resistant Ventilation in Humans. J Neurosci 2017; 36:10673-10682. [PMID: 27733617 DOI: 10.1523/jneurosci.2376-16.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
Spontaneous ventilation in mammals is driven by automatic brainstem networks that generate the respiratory rhythm and increase ventilation in the presence of increased carbon dioxide production. Hypocapnia decreases the drive to breathe and induces apnea. In humans, this occurs during sleep but not during wakefulness. We hypothesized that hypocapnic breathing would be associated with respiratory-related cortical activity similar to that observed during volitional breathing, inspiratory constraints, or in patients with defective automatic breathing (preinspiratory potentials). Nineteen healthy subjects were studied under passive (mechanical ventilation, n = 10) or active (voluntary hyperventilation, n = 9) profound hypocapnia. Ventilatory and electroencephalographic recordings were performed during voluntary sniff maneuvers, normocapnic breathing, hypocapnia, and after return to normocapnia. EEG recordings were analyzed with respect to the ventilatory flow signal to detect preinspiratory potentials in frontocentral electrodes and to construct time-frequency maps. After passive hyperventilation, hypocapnia was associated with apnea in 3 cases and ventilation persisted in 7 cases (3 and 6 after active hyperventilation, respectively). No respiratory-related EEG activity was observed in subjects with hypocapnia-related apneas. In contrast, preinspiratory potentials were present at vertex recording sites in 12 of the remaining 13 subjects (p < 0.001). This was corroborated by time-frequency maps. This study provides direct evidence of a cortical substrate to hypocapnic breathing in awake humans and fuels the notion of corticosubcortical cooperation to preserve human ventilation in a variety of situations. Of note, maintaining ventilatory activity at low carbon dioxide levels is among the prerequisites to speech production insofar as speech often induces hypocapnia. SIGNIFICANCE STATEMENT Human ventilatory activity persists, during wakefulness, even when hypocapnia makes it unnecessary. This peculiarity of human breathing control is important to speech and speech-breathing insofar as speech induces hypocapnia. This study evidences a specific respiratory-related cortical activity. This suggests that human hypocapnic breathing is driven, at least in part, by cortical mechanisms similar to those involved in volitional breathing, in breathing against mechanical constraints or with weak inspiratory muscle, and in patients with defective medullary breathing pattern generators. This fuels the notion that the human ventilatory drive during wakefulness often results from a corticosubcortical cooperation, and opens new avenues to study certain ventilatory and speech disorders.
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26
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Attali V, Straus C, Pottier M, Buzare MA, Morélot-Panzini C, Arnulf I, Similowski T. Normal sleep on mechanical ventilation in adult patients with congenital central alveolar hypoventilation (Ondine's curse syndrome). Orphanet J Rare Dis 2017; 12:18. [PMID: 28115003 PMCID: PMC5256543 DOI: 10.1186/s13023-017-0569-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/11/2017] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this study was to describe the sleep structure (especially slow wave sleep) in adults with congenital central hypoventilation syndrome (CCHS), a rare genetic disease due to mutations in the PHOX2B gene. Fourteen patients aged 23 (19.0; 24.8) years old (median [1rst-3rd quartiles]) with CCHS underwent a sleep interview and night-time attended polysomnography with their ventilatory support. Their sleep variables were compared to those collected in 15 healthy control subjects matched for age, sex and body mass index. Results The latency to N3 sleep was shorter in patients (26.3 min [24.0; 30.1]) than in controls (49.5 min [34.3; 66.9]; P = 0.005), and sleep onset latency tended to be shorter in patients (14.0 min [7.0; 20.5]) than in controls (33.0 min [18.0; 49.0]; P = 0.052). Total sleep time, sleep stage percentages, sleep fragmentation as well as respiratory and movement index were within normal ranges and not different between groups. Conclusions Normal sleep in adult patients with CCHS and adequate ventilator support indicates that the PHOX2 gene mutations do not affect brain sleep networks. Consequently, any complaint of disrupted sleep should prompt clinicians to look for the usual causes of sleep disorders, primarily inadequate mechanical ventilation. Shorter N3 latency may indicate a higher need for slow wave sleep, to compensate for the abnormal respiratory-related cortical activity during awake quiet breathing observed in patients with CCH.
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Affiliation(s)
- Valérie Attali
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. .,Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France. .,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.
| | - Christian Straus
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.,Service d'Explorations Fonctionnelles Respiratoires de l'Exercice et de la Dyspnée EFRED, F-75013, Paris, France
| | - Michel Pottier
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France
| | - Marie-Annick Buzare
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Unité ambulatoire d'Assistance Respiratoire à Domicile, F-75013, Paris, France.,Service de Pneumologie et Réanimation Médicale, Département R3S, Hopitaux Universitaires Pitié-Salpêtrière Charles Foix, AP-HP, F-75013, Paris, France
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France.,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.,Brain Research Institute-UPMC Paris 6 Univ Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Branche "Adultes" du Centre de Référence du Syndrome d'Ondine, F-75013, Paris, France.,Service de Pneumologie et Réanimation Médicale, Département R3S, Hopitaux Universitaires Pitié-Salpêtrière Charles Foix, AP-HP, F-75013, Paris, France
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27
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Raux M, Demoule A, Redolfi S, Morelot-Panzini C, Similowski T. Reduced Phrenic Motoneuron Recruitment during Sustained Inspiratory Threshold Loading Compared to Single-Breath Loading: A Twitch Interpolation Study. Front Physiol 2016; 7:537. [PMID: 27891099 PMCID: PMC5102887 DOI: 10.3389/fphys.2016.00537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022] Open
Abstract
In humans, inspiratory constraints engage cortical networks involving the supplementary motor area. Functional magnetic resonance imaging (fMRI) shows that the spread and intensity of the corresponding respiratory-related cortical activation dramatically decrease when a discrete load becomes sustained. This has been interpreted as reflecting motor cortical reorganization and automatisation, but could proceed from sensory and/or affective habituation. To corroborate the existence of motor reorganization between single-breath and sustained inspiratory loading (namely changes in motor neurones recruitment), we conducted a diaphragm twitch interpolation study based on the hypothesis that motor reorganization should result in changes in the twitch interpolation slope. Fourteen healthy subjects (age: 21–40 years) were studied. Bilateral phrenic stimulation was delivered at rest, upon prepared and targeted voluntary inspiratory efforts (“vol”), upon unprepared inspiratory efforts against a single-breath inspiratory threshold load (“single-breath”), and upon sustained inspiratory efforts against the same type of load (“continuous”). The slope of the relationship between diaphragm twitch transdiaphragmatic pressure and the underlying transdiaphragmatic pressure was −1.1 ± 0.2 during “vol,” −1.5 ± 0.7 during “single-breath,” and −0.6 ± 0.4 during “continuous” (all slopes expressed in percent of baseline.percent of baseline−1) all comparisons significant at the 5% level. The contribution of the diaphragm to inspiration, as assessed by the gastric pressure to transdiaphragmatic pressure ratio, was 31 ± 17% during “vol,” 22 ± 16% during “single-breath” (p = 0.13), and 19 ± 9% during “continuous” (p = 0.0015 vs. “vol”). This study shows that the relationship between the amplitude of the transdiaphragmatic pressure produced by a diaphragm twitch and its counterpart produced by the underlying diaphragm contraction is not unequivocal. If twitch interpolation is interpreted as reflecting motoneuron recruitment, this study supports motor reorganization compatible with “diaphragm sparing” when an inspiratory threshold load becomes sustained.
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Affiliation(s)
- Mathieu Raux
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie-RéanimationParis, France
| | - Alexandre Demoule
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département"R3S")Paris, France
| | - Stefania Redolfi
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S")Paris, France
| | - Capucine Morelot-Panzini
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département"R3S")Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département"R3S")Paris, France
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28
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Georges M, Morawiec E, Raux M, Gonzalez-Bermejo J, Pradat PF, Similowski T, Morélot-Panzini C. Cortical drive to breathe in amyotrophic lateral sclerosis: a dyspnoea-worsening defence? Eur Respir J 2016; 47:1818-28. [DOI: 10.1183/13993003.01686-2015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/19/2016] [Indexed: 11/05/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease causing diaphragm weakness that can be partially compensated by inspiratory neck muscle recruitment. This disappears during sleep, which is compatible with a cortical contribution to the drive to breathe. We hypothesised that ALS patients with respiratory failure exhibit respiratory-related cortical activity, relieved by noninvasive ventilation (NIV) and related to dyspnoea.We studied 14 ALS patients with respiratory failure. Electroencephalographic recordings (EEGs) and electromyographic recordings of inspiratory neck muscles were performed during spontaneous breathing and NIV. Dyspnoea was evaluated using the Multidimensional Dyspnea Profile.Eight patients exhibited slow EEG negativities preceding inspiration (pre-inspiratory potentials) during spontaneous breathing. Pre-inspiratory potentials were attenuated during NIV (p=0.04). Patients without pre-inspiratory potentials presented more advanced forms of ALS and more severe respiratory impairment, but less severe dyspnoea. Patients with pre-inspiratory potentials had stronger inspiratory neck muscle activation and more severe dyspnoea during spontaneous breathing.ALS-related diaphragm weakness can engage cortical resources to augment the neural drive to breathe. This might reflect a compensatory mechanism, with the intensity of dyspnoea a negative consequence. Disease progression and the corresponding neural loss could abolish this phenomenon. A putative cognitive cost should be investigated.
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Nierat MC, Demiri S, Dupuis-Lozeron E, Allali G, Morélot-Panzini C, Similowski T, Adler D. When Breathing Interferes with Cognition: Experimental Inspiratory Loading Alters Timed Up-and-Go Test in Normal Humans. PLoS One 2016; 11:e0151625. [PMID: 26978782 PMCID: PMC4792478 DOI: 10.1371/journal.pone.0151625] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/29/2016] [Indexed: 12/14/2022] Open
Abstract
Human breathing stems from automatic brainstem neural processes. It can also be operated by cortico-subcortical networks, especially when breathing becomes uncomfortable because of external or internal inspiratory loads. How the “irruption of breathing into consciousness” interacts with cognition remains unclear, but a case report in a patient with defective automatic breathing (Ondine's curse syndrome) has shown that there was a cognitive cost of breathing when the respiratory cortical networks were engaged. In a pilot study of putative breathing-cognition interactions, the present study relied on a randomized design to test the hypothesis that experimentally loaded breathing in 28 young healthy subjects would have a negative impact on cognition as tested by “timed up-and-go” test (TUG) and its imagery version (iTUG). Progressive inspiratory threshold loading resulted in slower TUG and iTUG performance. Participants consistently imagined themselves faster than they actually were. However, progressive inspiratory loading slowed iTUG more than TUG, a finding that is unexpected with regard to the known effects of dual tasking on TUG and iTUG (slower TUG but stable iTUG). Insofar as the cortical networks engaged in response to inspiratory loading are also activated during complex locomotor tasks requiring cognitive inputs, we infer that competition for cortical resources may account for the breathing-cognition interference that is evidenced here.
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Affiliation(s)
- Marie-Cécile Nierat
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Suela Demiri
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Elise Dupuis-Lozeron
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013, Paris, France
- * E-mail:
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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Hudson AL, Navarro-Sune X, Martinerie J, Pouget P, Raux M, Chavez M, Similowski T. Electroencephalographic detection of respiratory-related cortical activity in humans: from event-related approaches to continuous connectivity evaluation. J Neurophysiol 2016; 115:2214-23. [PMID: 26864771 DOI: 10.1152/jn.01058.2015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
Abstract
The presence of a respiratory-related cortical activity during tidal breathing is abnormal and a hallmark of respiratory difficulties, but its detection requires superior discrimination and temporal resolution. The aim of this study was to validate a computational method using EEG covariance (or connectivity) matrices to detect a change in brain activity related to breathing. In 17 healthy subjects, EEG was recorded during resting unloaded breathing (RB), voluntary sniffs, and breathing against an inspiratory threshold load (ITL). EEG were analyzed by the specially developed covariance-based classifier, event-related potentials, and time-frequency (T-F) distributions. Nine subjects repeated the protocol. The classifier could accurately detect ITL and sniffs compared with the reference period of RB. For ITL, EEG-based detection was superior to airflow-based detection (P < 0.05). A coincident improvement in EEG-airflow correlation in ITL compared with RB (P < 0.05) confirmed that EEG detection relates to breathing. Premotor potential incidence was significantly higher before inspiration in sniffs and ITL compared with RB (P < 0.05), but T-F distributions revealed a significant difference between sniffs and RB only (P < 0.05). Intraclass correlation values ranged from poor (-0.2) to excellent (1.0). Thus, as for conventional event-related potential analysis, the covariance-based classifier can accurately predict a change in brain state related to a change in respiratory state, and given its capacity for near "real-time" detection, it is suitable to monitor the respiratory state in respiratory and critically ill patients in the development of a brain-ventilator interface.
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Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia;
| | - Xavier Navarro-Sune
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jacques Martinerie
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Pierre Pouget
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Mathieu Raux
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique-Hopitaux de Paris (AP-HP), Groupe Hospitalier Pitie-Salpêtrière-Charles Foix, Département d'Anesthésie-Réanimation, Paris, France; and
| | - Mario Chavez
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitie-Salpêtrière-Charles Foix, Service de Pneumologie et Réanimation Medicale, Paris, France
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Healy F, Marcus CL. Care of the Child with Congenital Central Hypoventilation Syndrome. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Launois C, Attali V, Georges M, Raux M, Morawiec E, Rivals I, Arnulf I, Similowski T. Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome. Sleep 2015; 38:1743-9. [PMID: 26158887 DOI: 10.5665/sleep.5156] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/22/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The obstructive sleep apnea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered, imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Experimental inspiratory loading in normal subjects elicits respiratory-related cortical activity. The objective of this study was to test whether awake OSAS patients would exhibit a similar cortical activity. DESIGN Descriptive physiology study. SETTING Sleep laboratory in a large university affiliated tertiary hospital. PATIENTS 26 patients with moderate OSAS according to polysomnography (5 < apnea-hypopnea index [AHI] ≤ 30, n = 14) or severe OSAS (AHI > 30, n = 12); 13 non-OSAS patients for comparison. INTERVENTIONS None. MEASUREMENTS Respiratory time-locked electroencephalographic segments ensemble averaged and analyzed for slow premotor potentials preceding inspiration ("pre-inspiratory potentials" [PIPs]). RESULTS PIPs were present in 1/13 controls and 11/26 patients (P = 0.0336; 4/14 "moderate" and 7/12 "severe" patients). Awake OSAS patients therefore exhibit respiratory-related cortical activity during quiet breathing significantly more frequently than non-OSAS individuals. The corresponding PIPs resemble those observed during prepared voluntary inspirations and in response to experimental inspiratory loads in normal subjects, which involve a cortical network comprising the supplementary motor area. CONCLUSIONS A respiratory-related cortical activity could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in obstructive sleep apnea, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. Whether or not such cortical compensatory mechanisms have cognitive consequences remains to be determined.
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Affiliation(s)
- Claire Launois
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Valérie Attali
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Marjolaine Georges
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Mathieu Raux
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Surveillance Post-Interventionnelle et d'Accueil des Polytraumatisés (Département d'Anesthésie Réanimation), Paris, France
| | - Elise Morawiec
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | - Isabelle Rivals
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Ecole Supérieure de Physique et de Chimie de la Ville de Paris, Paris, France
| | - Isabelle Arnulf
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
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Nierat MC, Hudson AL, Chaskalovic J, Similowski T, Laviolette L. Repetitive transcranial magnetic stimulation over the supplementary motor area modifies breathing pattern in response to inspiratory loading in normal humans. Front Physiol 2015; 6:273. [PMID: 26483701 PMCID: PMC4586419 DOI: 10.3389/fphys.2015.00273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/14/2015] [Indexed: 11/13/2022] Open
Abstract
In awake humans, breathing depends on automatic brainstem pattern generators. It is also heavily influenced by cortical networks. For example, functional magnetic resonance imaging and electroencephalographic data show that the supplementary motor area becomes active when breathing is made difficult by inspiratory mechanical loads like resistances or threshold valves, which is associated with perceived respiratory discomfort. We hypothesized that manipulating the excitability of the supplementary motor area with repetitive transcranial magnetic stimulation would modify the breathing pattern response to an experimental inspiratory load and possibly respiratory discomfort. Seven subjects (three men, age 25 ± 4) were studied. Breathing pattern and respiratory discomfort during inspiratory loading were described before and after conditioning the supplementary motor area with repetitive stimulation, using an excitatory paradigm (5 Hz stimulation), an inhibitory paradigm, or sham stimulation. No significant change in breathing pattern during loading was observed after sham conditioning. Excitatory conditioning shortened inspiratory time (p = 0.001), decreased tidal volume (p = 0.016), and decreased ventilation (p = 0.003), as corroborated by an increased end-tidal expired carbon dioxide (p = 0.013). Inhibitory conditioning did not affect ventilation, but lengthened expiratory time (p = 0.031). Respiratory discomfort was mild under baseline conditions, and unchanged after conditioning of the supplementary motor area. This is the first study to show that repetitive transcranial magnetic stimulation conditioning of the cerebral cortex can alter breathing pattern. A 5 Hz conditioning protocol, known to enhance corticophrenic excitability, can reduce the amount of hyperventilation induced by inspiratory threshold loading. Further studies are needed to determine whether and under what circumstances rTMS can have an effect on dyspnoea.
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Affiliation(s)
- Marie-Cécile Nierat
- UMR S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale, University Pierre et Marie Curie Paris, France
| | - Anna L Hudson
- Neuroscience Research Australia and University of New South Wales Sydney, NSW, Australia
| | - Joël Chaskalovic
- Institut Jean Le Rond D'Alembert, University Pierre et Marie Curie Paris, France
| | - Thomas Similowski
- UMR S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale, University Pierre et Marie Curie Paris, France ; Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale Paris, France
| | - Louis Laviolette
- UMR S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale, University Pierre et Marie Curie Paris, France ; Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec Québec, QC, Canada
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Morawiec E, Raux M, Kindler F, Laviolette L, Similowski T. Expiratory load compensation is associated with electroencephalographic premotor potentials in humans. J Appl Physiol (1985) 2015; 118:1023-30. [PMID: 25663669 DOI: 10.1152/japplphysiol.00201.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 02/02/2015] [Indexed: 11/22/2022] Open
Abstract
In normal humans during quiet breathing, expiration is mostly driven by elastic recoil of the lungs. Expiration becomes active when ventilation must be increased to meet augmented metabolic demands, or in response to expiratory loading, be it experimental or disease-related. The response to expiratory loading is considered to be mediated by both reflex and cortical mechanisms, but the latter phenomenon have not been neurophysiologically characterized. We recorded the EEG in 20 healthy volunteers (9 men, 11 women, age: 22 to 50 yr) during unloaded breathing, voluntary expirations, and in response to 50 cmH2O·l(-1)·s expiratory resistive load (ERL), 20 cmH2O expiratory threshold load (high ETL), and 10 cmH2O expiratory threshold load (low ETL). EEGs were processed by ensemble averaging expiratory time-locked segments and examined for pre-expiratory potentials, defined as a slow negative shift from the baseline signal preceding expiration, and suggestive of cortical preparation of expiration involving the supplementary motor area. Four subjects were excluded because of technical EEG problems. Pre-expiratory potentials were present in one subject at baseline and in all subjects during voluntary expirations. They were present in eight subjects during low ETL, in 15 subjects during high ETL, and in 13 subjets during ERL (control vs. low ETL, P = 0.008; control vs. high ETL, P < 0.001; and control vs. ERL, P < 0.001). Respiratory discomfort was more intense in the presence of pre-expiratory potentials (P < 0.001). These results provide a neurophysiological substrate to a cortical component of the physiological response to experimental expiratory loads in humans.
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Affiliation(s)
- Elise Morawiec
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique-Hópitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), Paris, France
| | - Mathieu Raux
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie-Réanimation, Paris, France; and Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Felix Kindler
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie-Réanimation, Paris, France; and Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Louis Laviolette
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique-Hópitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), Paris, France;
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Adler D, Herbelin B, Similowski T, Blanke O. Reprint of “Breathing and sense of self: Visuo-respiratory conflicts alter body self-consciousness”. Respir Physiol Neurobiol 2014; 204:131-7. [DOI: 10.1016/j.resp.2014.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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36
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Electroencephalographic evidence for a respiratory-related cortical activity specific of the preparation of prephonatory breaths. Respir Physiol Neurobiol 2014; 204:64-70. [DOI: 10.1016/j.resp.2014.06.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/19/2022]
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Adler D, Herbelin B, Similowski T, Blanke O. Breathing and sense of self: Visuo–respiratory conflicts alter body self-consciousness. Respir Physiol Neurobiol 2014; 203:68-74. [DOI: 10.1016/j.resp.2014.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 07/16/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Sharman M, Gallea C, Lehongre K, Galanaud D, Nicolas N, Similowski T, Cohen L, Straus C, Naccache L. The cerebral cost of breathing: an FMRI case-study in congenital central hypoventilation syndrome. PLoS One 2014; 9:e107850. [PMID: 25268234 PMCID: PMC4182437 DOI: 10.1371/journal.pone.0107850] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/16/2014] [Indexed: 11/19/2022] Open
Abstract
Certain motor activities - like walking or breathing - present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks - including various frontal lobe areas - subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the “resting state” pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS), a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB), mechanical ventilation (MV) restored the default mode network (DMN) associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the active maintenance of cortical control over a continuous motor activity impacts on brain functioning and cognition.
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Affiliation(s)
- Mike Sharman
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
| | - Cécile Gallea
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, (CENIR), Paris, France
| | - Katia Lehongre
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
| | - Damien Galanaud
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, (CENIR), Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié- Salpêtrière Charles Foix, Department of Neuroradiology, Paris, France
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - Nathalie Nicolas
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié- Salpêtrière Charles Foix, Centre d'Investigation Clinique 1421, Paris, France
| | - Thomas Similowski
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
| | - Laurent Cohen
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière Charles Foix, Department of Neurology, Paris, France
| | - Christian Straus
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département “R3S”), Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares “syndrome d'Ondine”, Paris, France
| | - Lionel Naccache
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié- Salpêtrière Charles Foix, Centre d'Investigation Clinique 1421, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière Charles Foix, Department of Neurology, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière Charles Foix, Department of Neurophysiology, Paris, France
- * E-mail:
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39
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Allali G, Perrig S, Cleusix M, Herrmann FR, Adler D, Gex G, Armand S, Janssens JP, Pepin JL, Assal F. Gait abnormalities in obstructive sleep apnea and impact of continuous positive airway pressure. Respir Physiol Neurobiol 2014; 201:31-3. [PMID: 24999279 DOI: 10.1016/j.resp.2014.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/20/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
We aimed to determine the effect of continuous positive airway pressure (CPAP) on gait in obstructive sleep apnea (OSA) patients. Gait during single and dual tasks was recorded in 15 OSA patients at baseline and after 8 weeks of CPAP therapy. Step and stance time improved after CPAP. We showed a specific dual-task effect in the condition of verbal fluency. Eight weeks of CPAP seems to improve gait of OSA patients that are specifically disturbed by the dual task of verbal fluency.
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Affiliation(s)
- G Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - S Perrig
- Sleep Research Laboratory, Geneva University Hospital and University of Geneva, Switzerland
| | - M Cleusix
- Department of Neurology, Geneva University Hospitals and University of Geneva, Switzerland
| | - F R Herrmann
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospital and University of Geneva, Switzerland
| | - D Adler
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Switzerland
| | - G Gex
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Switzerland
| | - S Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland
| | - J P Janssens
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Switzerland
| | - J L Pepin
- Sleep Research Laboratory, Geneva University Hospital and University of Geneva, Switzerland; Univ. Grenoble Alpes, HP2, Inserm, HP2 (U1042), 38043 Grenoble, France
| | - F Assal
- Department of Neurology, Geneva University Hospitals and University of Geneva, Switzerland
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