Interaction of Hypoxia and Hypercapnia on Respiratory Drive in Patients with COPD

Erbland, Marcia L.; Ebert, Richard V.; Snow, Sharon L.

doi:10.1378/chest.97.6.1289

Cited by 29 publications

(17 citation statements)

References 15 publications

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“…If they fail, OHS may appear. Others have hypothesized that hyperinflation of the lung may also decrease mouth occlusion response [53]. During sleep factors related to decreased mouth occlusion pressure are respiratory muscle fatigue, related to the mechanical disadvantage of chest wall hyperinflation, and reduced FRC, related to supine posture and sleep state, as discussed earlier (Figure 2).…”

Section: Overlap Syndromementioning

confidence: 85%

Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation

Verbraecken

McNicholas

2013

Respir Res

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The overlap syndrome of obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD), in addition to obesity hypoventilation syndrome, represents growing health concerns, owing to the worldwide COPD and obesity epidemics and related co-morbidities. These disorders constitute the end points of a spectrum with distinct yet interrelated mechanisms that lead to a considerable health burden. The coexistence OSA and COPD seems to occur by chance, but the combination can contribute to worsened symptoms and oxygen desaturation at night, leading to disrupted sleep architecture and decreased sleep quality. Alveolar hypoventilation, ventilation-perfusion mismatch and intermittent hypercapnic events resulting from apneas and hypopneas contribute to the final clinical picture, which is quite different from the “usual” COPD. Obesity hypoventilation has emerged as a relatively common cause of chronic hypercapnic respiratory failure. Its pathophysiology results from complex interactions, among which are respiratory mechanics, ventilatory control, sleep-disordered breathing and neurohormonal disturbances, such as leptin resistance, each of which contributes to varying degrees in individual patients to the development of obesity hypoventilation. This respiratory embarrassment takes place when compensatory mechanisms like increased drive cannot be maintained or become overwhelmed.Although a unifying concept for the pathogenesis of both disorders is lacking, it seems that these patients are in a vicious cycle. This review outlines the major pathophysiological mechanisms believed to contribute to the development of these specific clinical entities. Knowledge of shared mechanisms in the overlap syndrome and obesity hypoventilation may help to identify these patients and guide therapy.

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Section: Overlap Syndromementioning

confidence: 85%

Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation

Verbraecken

McNicholas

2013

Respir Res

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“…In subjects with chronic hypercapnia, there is an increased blood bicarbonate concentration, which may inhibit CO 2 sensitivity and decreases mouth occlusion pressure response (Radwan et al 1995). Other authors have postulated that hyperinflation of the lung may also decrease mouth occlusion pressure response (Erbland et al 1990). …”

Section: Overlap Syndromementioning

confidence: 99%

Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences

Zamarrón¹

2008

COPD

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Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two diseases that often coexist within an individual. This coexistence is known as overlap syndrome and is the result of chance rather than a pathophysiological link. Although there are claims of a very high incidence of OSAS in COPD patients, recent studies report that it is similar to the general population. Overlap patients present sleep-disordered breathing associated to upper and lower airway obstruction and a reduction in respiratory drive. These patients present unique characteristics, which set them apart from either COPD or OSAS patients. COPD and OSAS are independent risk factors for cardiovascular events and their coexistence in overlap syndrome probably increases this risk. The mechanisms underlying cardiovascular risk are still unclear, but may involve systemic inflammation, endothelial dysfunction, and tonic elevation of sympathetic neural activity. The treatment of choice for overlap syndrome in stable patients is CPAP with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep.

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“…Indeed, a brisk HVR would seem important in patients with lung disease to maintain oxygenation, particularly in situations where they may be exposed to acute hypoxic events. Previous studies have shown both an increase (13) and decrease (15) in the HVR in COPD patients, but how these responses compare to age-related healthy control subjects is unclear. In addition, the cerebrovascular response to hypoxia determines the tissue acidity (H ϩ / CO 2 ) of the central chemoreceptors, thus contributing to the overall ventilatory response to hypoxia.…”

mentioning

confidence: 95%

Cerebrovascular and ventilatory responses to acute isocapnic hypoxia in healthy aging and lung disease: effect of vitamin C

Hartmann

Waltz

Kissel

et al. 2015

Journal of Applied Physiology

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Acute hypoxia increases cerebral blood flow (CBF) and ventilation (V̇e). It is unknown if these responses are impacted with normal aging, or in patients with enhanced oxidative stress, such as (COPD). The purpose of the study was to 1) investigate the effects of aging and COPD on the cerebrovascular and ventilatory responses to acute hypoxia, and 2) to assess the effect of vitamin C on these responses during hypoxia. In 12 Younger, 14 Older, and 12 COPD, we measured peak cerebral blood flow velocity (V̄p; index of CBF), and V̇e during two 5-min periods of acute isocapnic hypoxia, under conditions of 1) saline-sham; and 2) intravenous vitamin C. Antioxidants [vitamin C, superoxide dismutase (SOD), glutathione peroxidase, and catalase], oxidative stress [malondialdehyde (MDA) and advanced protein oxidation product], and nitric oxide metabolism end products (NOx) were measured in plasma. Following the administration of vitamin C, vitamin C, SOD, catalase, and MDA increased, while NOx decreased. V̄p and V̇e sensitivity to hypoxia was reduced in Older by ∼60% (P < 0.02). COPD patients exhibited similar V̄p and V̇e responses to Older (P > 0.05). Vitamin C did not have an effect on the hypoxic V̇e response but selectively decreased the V̄p sensitivity in Younger only. These findings suggest a reduced integrative reflex (i.e., cerebrovascular and ventilatory) during acute hypoxemia in healthy older adults. Vitamin C does not appear to have a large influence on the cerebrovascular or ventilatory responses during acute hypoxia.

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Interaction of Hypoxia and Hypercapnia on Respiratory Drive in Patients with COPD

Cited by 29 publications

References 15 publications

Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation

Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation

Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences

Cerebrovascular and ventilatory responses to acute isocapnic hypoxia in healthy aging and lung disease: effect of vitamin C

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