A B S T R A C T The ventilatory response to hypoxia was studied in two groups of subjects with abnormal sympathetic nervous control: (a) human subjects with familial dysautonomia (Riley-Day syndrome), and (b) unanesthetized goats treated with an alpha-adrenergic blocking agent (phenoxybenzamine). The ventilatory response to hypoxia was evaluated in two ways: (a) from the slope of the relationship between ventilation and alveolar Pco, during the rebreathing of hypoxic and hyperoxic gases, and (b) from the change in ventilation produced when hypoxia was abruptly relieved.The ventilatory and circulatory responses of the unanesthetized, phenoxybenzamine-treated goats were qualitatively similar to those of dysautonomic patients. In contrast to the sustained stimulation of ventilation produced by hypoxia in normal subjects, hypoxia either did not change, or decreased, the VE-PAco, slope of dysautonomic patients and phenoxybenzamine-treated goats; CO2-free hypoxia produced a fleeting hyperventilation, which was followed by apnea when hypoxia was abruptly relieved. Unlike normal subjects, the dysautonomic patients and phenoxybenzamine-treated goats became hypotensive while hypoxic.The results indicate that peripheral chemoreceptor reflex responses to hypoxia are preserved in subjects in whom sympathetic nervous responses are impaired. However, the central nervous depression of ventilation by hypoxia is enhanced simultaneously. The inordinate central depression is attributed to the inability of the dysautonomic subjects and goats to maintain systemic blood pressure and, consequently, cerebral blood flowThe present address of Doctors Edelman, Cherniack, Lahiri, and Fishman is Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa. Dr. Richards' present address is Department of Medicine, St. Luke's Hospital, New York.Received for publication 2 June 1969 and in revised form 9 February 1970. during hypoxia, thereby aggrevating central nervous hypoxia.
INTRODUCTIONThe normal ventilatory response to hypoxia requires not only the proper sensing of the hypoxic stimulus by the peripheral chemoreceptors, but also the integration of the nervous output from the peripheral chemoreceptors with other neural and chemical stimuli that converge upon the central nervous system. The role of the sympathetic nervous system in this complicated interplay is not settled. Studies involving the infusion of norepinephrine in human subjects have suggested that the sympathetic nervous system may modulate the ventilatory response to acute hypoxia by controlling blood flow through the carotid body; i.e., diminished flow would elicit an increased chemoreceptor response (1). However, observations on an isolated peripheral chemoreceptor (carotid body) have not been corroborative; i.e., the expected decrease in the nervous discharge of the chemoreceptor to hypoxia after sympatholytic agents were applied did not occur (2).In the present study, a different approach to the problem was used. The ventilatory response to acute h...