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1 Department of Medicine, University of Wisconsin, Madison, WI, USA; Pulmonary Physiology Laboratory, Middleton Memorial Veterans Hospital, Madison, WI, USA
2 Department of Medicine, University of Wisconsin, Madison, WI, USA
3 Population Health Sciences, University of Wisconsin, Madison, WI, USA
* To whom correspondence should be addressed. E-mail: axie{at}wisc.edu.
In order to investigate the contribution of the peripheral chemoreceptors to the susceptibility to post-hyperventilation apnea, we evaluated the time-course and magnitude of hypocapnia required to produce apnea at different levels of peripheral chemoreceptor activation produced by exposure to three levels of inspired PO2. We measured the apneic threshold and the apnea latency in nine normal sleeping subjects in response to augmented breaths during normoxia (room air), hypoxia (SaO2=78-80%) and hyperoxia (FIO2=50-52%). Pressure support mechanical ventilation in the assist mode was employed to introduce single or a variable number of consecutive, sigh-like breaths to cause apnea. The apnea latency was measured from the end-inspiration of the first augmented breath to the onset of apnea. It was 12.2±1.1 second (s)during normoxia, which was similar to the lung to ear circulation delay of 11.7s in these subjects. Hypoxia shortened the apnea latency (6.3±0.8s, p<0.05) while hyperoxia prolonged it (71.5±13.8s, p<0.01). The apneic threshold end-tidal PCO2 (PETCO2) was defined as the PETCO2 at the onset of apnea. During hypoxia, the apneic threshold PETCO2 was higher (38.9±1.7 mmHg, p<0.01) compared to normoxia (35.8±1.1 mmHg) while during hyperoxia, it was lower (33.0±0.8 mmHg, p<0.05). Furthermore, the difference between the eupneic PETCO2 and apnea threshold PETCO2 (
PETCO2) was smaller during hypoxia (3.0±1.0 mmHg, p<001) and greater during hyperoxia (10.6±0.8 mmHg, p<0.05) compared to normoxia (8.0±0.6 mmHg). Correspondingly, the hypocapnic ventilatory response slope to CO2 below the eupneic PETCO2 was increased by hypoxia (3.44±0.63 Lxmin-1xmmHg-1, p<0.05) and decreased by hyperoxia (0.63±0.04 Lxmin-1xmmHg-1,p<0.05) compared to normoxia (0.79± 0.05 Lxmin-1xmm Hg-1). These findings indicate that post-hyperventilation apnea is initiated by the peripheral chemoreceptors, and that the varying susceptibility to apnea during hypoxia versus hyperoxia is influenced by the relative activity of these receptors.
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