Mechanism of Hemoglobin Desaturation During Rapid-Eye-Movement Sleep in Normal Subjects and in Patients with Cystic Fibrosis<sup>1,</sup><sup>2</sup>

Müller, Néstor L.; Francis, P.; Gurwitz, Dennis; Levison, Henry; Bryan, A. C.

doi:10.1164/arrd.1980.121.3.463

Cited by 145 publications

(62 citation statements)

References 19 publications

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“…Hypoxemia may occur during sleep in individuals with chronic lung disease [e.g. cystic fibrosis (2), bronchopulmonary dysplasia (3), asthma (4)] and/or during central or obstructive apnea. The usual respiratory response to hypoxemia is an increase in ventilation which tends to increase the alveolar and arterial oxygen tension.…”

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confidence: 99%

Arousal from Sleep during Rapidly Developing Hypoxemia in Lambs

Fewell

Baker

1987

Pediatr Res

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ABSTRACT. Arousal is an important protective response that may prevent severe hypoxemia and death during sleep. However, very little is known about arousal from sleep in response to respiratory stimuli in newborns. Experiments were therefore done to investigate the arousal response from sleep to rapidly developinghypoxemia in eight lambs. Each lamb was anesthetized and instrumented for record--ings of electrocorticogram, electrooculogram, nuchal and diaphragm electromyograms, and measurements of arterial hemoglobin oxygen saturation. A tracheotomy was done and a tracheostomy tube placed in the trachea so that the fraction of inspired oxygen could be changed quickly. No sooner than 3 days after surgery, measurements were made in quiet sleep and active sleep (AS) during 30-s control periods when the animals were breathing 21% oxygen and during experimental periods of hypoxemia when the animals were breathing either 10,5, or 0% oxygen in nitrogen. During quiet sleep, arousal occurred at similar arterial hemoglobin oxygen saturations (81 + 6% on 10% 0 2 , 80 + 5% on 5% O2 and 83 2 5% on 0% 0 2 ) suggesting that arousal was independent of the rate of change of arterial oxygen. However, during AS arousal occurred at different arterial hemoglobin oxygen saturations (76 + 6% on 10% 02, 55 2 11% on 5% 02, and 44 f 17% on 0% 02) suggesting that arousal was dependent on the rate of change of arterial oxygen. During some epochs of AS, electrocortical signs of cerebral hypoxia and primary apnea occurred before arousal. These data provide evidence that arousal from quiet sleep in response to hypoxemia occurs once an arousal threshold has been reached. However, during AS, arousal appears to follow an arousal latency once an arousal threshold has been reached. Furthermore, if the rate of change of oxygen is great enough during AS, signs of cerebral hypoxia and primary apnea may precede arousal. These data would allow one to speculate that if the rate of change of arterial oxygen is great enough during apnea in AS, arousal may fail to occur before hypoxic cerebral depression and ultimately death ensue. (Pediatr Res 22: [471][472][473][474][475][476][477]1987) Abbreviations ALTE, apparent life-threatening event Sa02, arterial hemoglobin oxygen saturation SIDS, sudden infant death syndrome

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confidence: 99%

Arousal from Sleep during Rapidly Developing Hypoxemia in Lambs

Fewell

Baker

1987

Pediatr Res

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“…). NIPPV resulted in significantly more sleep time being spent at Ptc,CO 2 <6.7 kPa, while in oxygen therapy significantly more time was spent at high Ptc,CO 2 fig. 2).…”

Section: Resultsmentioning

confidence: 88%

“…With advancing lung disease, patients with cystic fibrosis (CF) may develop clinically significant hypoxaemia and hypercapnia during sleep, particularly during rapid-eye movement (REM) sleep [1,2]. Domiciliary administration of supplemental oxygen improves nocturnal oxygenation in these patients, but it either does not modify or significantly aggravates concomitant alveolar hypoventilation [3,4].…”

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Nocturnal ventilatory support in patients with cystic fibrosis: comparison with supplemental oxygen

Gozal¹

1997

Eur Respir J

128

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Progressive deterioration of lung function in cystic fibrosis (CF) patients may lead to significant hypoxaemia and hypercapnia, especially during sleep. The effects of bi-level noninvasive positive pressure nasal mask ventilation (NIPPV) on respiration and sleep were compared to those of low-flow oxygen therapy in six CF patients (mean +/- SD age 22.3 +/- 4.7 yrs, with severe lung disease (forced expiratory volume in one second (FEV1) 29.4 +/- 3.4% predicted). Compared to the control night, NIPPV and oxygen therapy significantly improved overall night-time oxygen saturation during both rapid eye movement (REM) and non-rapid eye movement (NREM) sleep stages. However, significant increases in transcutaneous CO2 tension occurred during oxygen therapy, while NIPPV markedly improved alveolar ventilation during all sleep states. Sleep architecture and arousals remained unchanged during NIPPV and oxygen therapy treatment nights. We conclude that noninvasive positive pressure ventilation improves sleep-related hypoxaemia and hypercapnia in severe cystic fibrosis patients without affecting sleep. The long-term compliance and benefits of noninvasive positive pressure ventilation remain unclear.

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“…Bu da hipoksemiye neden olan ventilasyon perfüzyon uyumsuzluğuna yol açmaktadır. 8,[18][19][20][21] KOAH'TA UYKUYA BAĞLI SOLUNUM BOZUKLUKLARININ MEKANİZMASI Hipoventilasyon KOAH'lı hastalarda, uyku sırasında, özellikle de REM döneminde oluşan hipoventilasyonun oksijen desatürasyo-nuna yol açtığı gösterilmiştir. 22 Uykuda kaydedilen oksijen desatürasyon paterni tipiktir.…”

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Chronic Obstructive Pulmonary Disease and Sleep

Öztürk¹

2011

Solunum

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ÖZETUykunun hava yolu direnci, solunum kaslarının kasılımı ve solunum kontrolü dahil olmak üzere solunum sistemi üzerine etkileri bulunmaktadır. Kişinin solunum sorunları yoksa bu deği-şiklikler fizyolojik sınırlar içinde kalmaktadır. Ancak solunum sorunu olan olgularda ve özellikle kronik obstrüktif akciğer hastalarında (KOAH) uyku ciddi sorun yaratmaktadır. KOAH'ta solunumun kontrolü, uyku ve uyanıklıkta sağlıklı bireylerle aynı temel özelliklere sahip olmasına karşın, solunum ve gaz değişi-mi olumsuz etkilenmekte ve hızlı göz hareketleri (REM) sırasın-da solunum kaslarında görülen atoni hiperkapni ve hipoksiyi derinleştirmektedir. Hipoksi arousalları (uyanayazma), uyku bölünmelerini, pulmoner hipertansiyonu ve mortalite riskini artırmaktadır. KOAH'lı olgularda diğer kronik hastalıklarda olduğu gibi hipoksi olmaksızın uyku kalitesi bozulmakta ve tedavide kullanılan ilaçlar da uyku bölünmelerine ve uykusuzluğa neden olabilmektedir. Bu derlemede KOAH ile uyku bozukluklarının birlikteliğini, fizyolojik mekanizmaları ve kliniğe yansımalarını incelemek istedik.Anahtar sözcükler: hipoventilasyon, Kronik Obstrüktif Akciğer Hastalığı (KOAH), pozitif hava yolu basıncı, uyku bozuklukları ABSTRACTSleep affects the respirotory system by causing changes in airway resistance, respiratory muscle contractility, and central respiratory control. In an individual who has no respiratory problems, these changes remain within physiological limits. However, in patients with respiratory problems, especially chronic obstructive pulmonary disease (COPD), sleep creates a serious problem.Although the control of breathing in patients with COPD follows the same basic principles as it does in normal subjects, both awake and asleep, the respiratory and gas exchange is adversely affected and the atonia of respiratory muscles during rapid eye movement (REM) sleep deepens the hypoxia and hypercapnia. The hypoxia leads to increased arousals, sleep disruptions, pulmonary hypertension, and higher mortality. As with other chronic diseases, the quality of sleep among patients with COPD deteriorates without hypoxia and the drugs used in therapy cause sleep deprivations and insomnia. This review presents an examination of the association of COPD and sleep disorders, including the physiologic mechanisms and their clinical implications. Tablo I). [3][4][5] Bu makalede KOAH hastalarında görülen uyku bozukluklarının mekanizmaları ve tedavi yöntemleri, güncel literatür yardımıyla tartışılmaktadır. Keywords Solunum Dergisi t Önder Öztürk 67 GİRİŞ

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Mechanism of Hemoglobin Desaturation During Rapid-Eye-Movement Sleep in Normal Subjects and in Patients with Cystic Fibrosis^1,²

Cited by 145 publications

References 19 publications

Arousal from Sleep during Rapidly Developing Hypoxemia in Lambs

Arousal from Sleep during Rapidly Developing Hypoxemia in Lambs

Nocturnal ventilatory support in patients with cystic fibrosis: comparison with supplemental oxygen

Chronic Obstructive Pulmonary Disease and Sleep

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Mechanism of Hemoglobin Desaturation During Rapid-Eye-Movement Sleep in Normal Subjects and in Patients with Cystic Fibrosis1,2

Cited by 145 publications

References 19 publications

Arousal from Sleep during Rapidly Developing Hypoxemia in Lambs

Arousal from Sleep during Rapidly Developing Hypoxemia in Lambs

Nocturnal ventilatory support in patients with cystic fibrosis: comparison with supplemental oxygen

Chronic Obstructive Pulmonary Disease and Sleep

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Mechanism of Hemoglobin Desaturation During Rapid-Eye-Movement Sleep in Normal Subjects and in Patients with Cystic Fibrosis^1,²