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Vol. 84, Issue 1, 3-12, January 1998
Respiratory Investigation Unit, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada R3A 1R8
Meza, S., E. Giannouli, and M. Younes. Control of
breathing during sleep assessed by proportional assist ventilation. J. Appl. Physiol. 84(1): 3-12, 1998.
We used proportional assist ventilation (PAV) to evaluate the
sources of respiratory drive during sleep. PAV increases the slope of
the relation between tidal volume
(VT) and
respiratory muscle pressure output (Pmus). We reasoned that if
respiratory drive is dominated by chemical factors, progressive
increase of PAV gain should result in only a small increase in
VT because Pmus would be
downregulated substantially as a result of small decreases in
PCO2. In the presence of substantial
nonchemical sources of drive [believed to be the case in
rapid-eye-movement (REM) sleep] PAV should result in a substantial increase in minute ventilation and reduction
in PCO2 as the output related to the
chemically insensitive drive source is amplified severalfold. Twelve
normal subjects underwent polysomnography while connected to a PAV
ventilator. Continuous positive air pressure (5.2 ± 2.0 cmH2O) was administered to
stabilize the upper airway. PAV was increased in 2-min steps from 0 to
20, 40, 60, 80, and 90% of the subject's elastance and resistance.
VT, respiratory rate, minute
ventilation, and end-tidal CO2
pressure were measured at the different levels, and Pmus was
calculated. Observations were obtained in stage 2 sleep (n = 12), slow-wave sleep
(n = 11), and REM sleep
(n = 7). In all cases, Pmus was
substantially downregulated with increase in assist so that the
increase in VT, although
significant (P < 0.05), was small
(0.08 liter at the highest assist). There was no difference in response
between REM and non-REM sleep. We conclude that respiratory drive
during sleep is dominated by chemical control and that there is no
fundamental difference between REM and non-REM sleep in this regard.
REM sleep appears to simply add bidirectional noise to what is
basically a chemically controlled respiratory output.
rapid-eye-movement sleep; respiratory drive; tidal volume; partial pressure of carbon dioxide; unloading
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