Measuring the ventilatory response to hypoxia

After defining the current approach to measuring the hypoxic ventilatory response this paper explains why this method is not appropriate for comparisons between individuals or conditions, and does not adequately measure the parameters of the peripheral chemoreflex. A measurement regime is therefore proposed that incorporates three procedures. The first procedure measures the peripheral chemoreflex responsiveness to both hypoxia and CO₂ in terms of hypoxia's effects on the sensitivity and ventilatory recruitment threshold of the peripheral chemoreflex response to CO₂. The second and third procedures employ current methods for measuring the isocapnic and poikilocapnic ventilatory responses to hypoxia, respectively, over a period of 20 min. The isocapnic measure is used to determine the time course characteristics of hypoxic ventilatory decline and the poikilocapnic measure shows the ventilatory response to a hypoxic environment. A measurement regime incorporating these three procedures will permit a detailed assessment of the peripheral chemoreflex response to hypoxia that allows comparisons to be made between individuals and different physiological and environmental conditions.     

Heterogeneity of brainstem blood flow response to hypoxia in the anesthetized rat

Cerebral blood flow is strictly regulated during hypoxic stress. Because of the preponderant role of the brainstem in cardiorespiratory controls, blood flow response to hypoxia is stronger in this region than in the cortex. However, the brainstem is made up of various regions, which differ in their responsiveness to chemical stimuli. The objective of this study was to evaluate the distribution of blood flow during hypoxia using microsphere deposition methods in three brainstem regions containing key structures in cardiorespiratory controls: the nucleus tractus solitarus (NTS), the ventral respiratory groups (VRG) and the pontine respiratory groups (PRG). Microsphere injections were made during normoxia (FIO2 = 0.21) and after 15 min of hypoxia (FIO2 = 0.10). Based on this index, blood flow increase during hypoxia was higher in the VRG than in the dorsal part of the brainstem, containing the NTS and the PRG (P = 0.002, n = 10). These results suggest that blood flow response to hypoxia favours O2 delivery in brainstem regions involved in respiratory rhythm generation.     

Heterogeneity of brainstem blood flow response to hypoxia in the anesthetized rat

Cerebral blood flow is strictly regulated during hypoxic stress. Because of the preponderant role of the brainstem in cardiorespiratory controls, blood flow response to hypoxia is stronger in this region than in the cortex. However, the brainstem is made up of various regions which differ in their responsiveness to chemical stimuli. The objective of this study was to evaluate the distribution of blood flow during hypoxia using microsphere deposition methods in three brainstem regions containing key structures in cardiorespiratory controls: the nucleus tractus solitarus (NTS), the ventral respiratory groups (VRG) and the pontine respiratory groups (PRG). Microsphere injections were made during normoxia (FIO2=0.21) and after 15 min of hypoxia (FIO2=0.21). Based on this index, blood flow increase during hypoxia was higher in the VRG than in the dorsal part of the brainstem, containing the NTS and the PRG (P=0.002, n=10). These results suggest that blood flow response to hypoxia favours O(2) delivery in brainstem regions involved in respiratory rhythm generation.     

Changes in ventilatory response to hypoxia in the rat during growth and aging

The influence of aging on the ventilatory response to hypoxia was studied in the halothane-anesthetized male Wistar rats of various ages (1.5–20 months). The magnitude of increase in ventilation (normalized for body weight) during hypoxia in isocapnic conditions was attenuated in parallel with advancing age. However, ventilation in hyperoxia, normoxia or mild hypoxia did not differ among various age groups when the ventilatory volume was normalized for O₂ consumption. Furthermore, threshold end-tidal PO ₂ for ventilatory depression in deeper hypoxia became progressively lower with advancing age. The results suggest that the age change in ventilatory response to hypoxia depends largely upon the progressive reduction in basal O₂ requirement (consumption) with age.     

Modelling the dynamic ventilatory response to hypoxia in humans

A two-component dynamic model was used to describe the ventilatory response to sustained hypoxia in humans. One component (X_s) represents the stimulating effects of hypoxia and the other component (X_d), the hypoxic ventilatory decline. The total ventilatory response to hypoxia is represented by the sum of the two components. A nonlinearity is included to account for the nonlinear steady-state ventilatory response to hypoxia. A sensitivity analysis of the model indicates that, with a step change in as the input, all the parameters can be estimated from the data except for the nonlinearity. The relative sensitivity of the parameters from the model analysis was confirmed in an experimental study. However, comparing steps into hypoxia versus steps out of hypoxia we found a decrease in the gains of both components. The most likely explanation for the decrease in the gains is that the combination of X_s and X_d is not entirely additive. Other models may be required to completely describe the ventilatory response to inputs more complex than steps.     

Delayed ventilatory response to CO2 after carbonic anhydrase inhibition with acetazolamide administration in the anesthetized rat

In order to estimate to what extent the stimulatory action of CO2 on ventilation is mediated by the formation of H+, we studied effects on the temporal profile of ventilatory response to CO2 of carbonic anhydrase (CA) inhibition with acetazolamide in the halothane anesthetized spontaneously breathing rat. Since hydration reaction of CO2 yielding H+ is delayed by CA inhibition, the time courses of changes in tidal volume (VT), respiratory frequency (f), and minute ventilation (VE) in response to a stepwise increase in end-tidal PCO2 (delta PETCO2 15 mmHg) were compared before (control state) and after i.v. injection of acetazolamide (50 mg/kg) in the hyperoxic condition. In the control state, an increase in VT was significantly slower than that in f, and the mean response half-times (T1/2) for the increase in VT, f, and VE were 50.6, 18.1, and 31.0 s, respectively. After acetazolamide administration, responses to CO2, especially f-response and consequently VE-response became much slower, and the T1/2 for VT, f, and VE were 67.9, 55.0, and 63.0 s, respectively. The delay in VT-response was not statistically significant. The magnitude of increase in VE in the steady state hypercapnic stimulation was almost the same before and after acetazolamide administration. The results suggest that a rapid increase in f during CO2 inhalation occurs predominantly through an increase in H+ produced by hydration of CO2 with CA, whereas VT-response may occur without involvement of this process. The different time courses of VT- and f-responses and possible effects of molecular CO2 and/or H+ on the regulatory mechanisms for ventilatory pattern were discussed.     

Maturation of the initial ventilatory response to hypoxia in sleeping infants

In infants most previous studies of the hypoxic ventilatory response (HVR) have been conducted only during quiet sleep (QS) and arousal responses have not been considered. Our aim was to quantify the maturation of the HVR in term infants during both active sleep (AS) and QS over the first 6 months of life. Daytime polysomnography was performed on 15 healthy term infants at 2-5 weeks, 2-3 and 5-6 months after birth and infants were challenged with hypoxia (15% O2, balance N2). Tests in AS always resulted in arousal; in QS tests infants either aroused or did not arouse. A biphasic HVR was observed in non arousing tests at all three ages studied. The fall in SpO2 was more rapid in arousal tests at all three ages. At 2-5 weeks, in non-arousing QS tests, there was a greater fall in respiratory frequency (f) despite a smaller fall in SpO2 compared with 2-3 and 5-6 months. When infants aroused there was no difference in the HVR between sleep states or with postnatal age. However, when infants failed to arouse from QS, arterial desaturation was less in the younger infants despite a poorer HVR. We suggest that arousal in response to hypoxia, particularly in AS, is a vital survival mechanism throughout the first 6 months of life.     

Effects of intrathecal morphine on the ventilatory response to hypoxia

BACKGROUND: Intrathecal administration of morphine produces intense analgesia, but it depresses respiration, an effect that can be life-threatening. Whether intrathecal morphine affects the ventilatory response to hypoxia, however, is not known. METHODS: We randomly assigned 30 men to receive one of three study treatments in a double-blind fashion: intravenous morphine (0.14 mg per kilogram of body weight) with intrathecal placebo; intrathecal morphine (0.3 mg) with intravenous placebo; or intravenous and intrathecal placebo. The selected doses of intravenous and intrathecal morphine produce similar degrees of analgesia. The ventilatory response to hypercapnia, the subsequent response to acute hypoxia during hypercapnic breathing (targeted end-tidal partial pressures of expired oxygen and carbon dioxide, 45 mm Hg), and the plasma levels of morphine and morphine metabolites were measured at base line (before drug administration) and 1, 2, 4, 6, 8, 10, and 12 hours after drug administration. RESULTS: At base line, the mean (+/-SD) values for the ventilatory response to hypoxia (calculated as the difference between the minute ventilation during the second full minute of hypoxia and the fifth minute of hypercapnic ventilation) were similar in the three groups: 38.3+/-23.2 liters per minute in the placebo group, 33.5+/-16.4 liters per minute in the intravenous-morphine group, and 30.2+/-11.6 liters per minute in the intrathecal-morphine group (P=0.61). The overall ventilatory response to hypoxia (the area under the curve) was significantly lower after either intravenous morphine (20.2+/-10.8 liters per minute) or intrathecal morphine (14.5+/-6.4 liters per minute) than after placebo (36.8+/-19.2 liters per minute) (P=O.003). Twelve hours after treatment, the ventilatory response to hypoxia in the intrathecal-morphine group (19.9+/-8.9 liters per minute), but not in the intravenous-morphine group (30+/-15.8 liters per minute), remained significantly depressed as compared with the response in the placebo group (40.9+/-19.0 liters per minute) (P= 0.02 for intrathecal morphine vs. placebo). Plasma concentrations of morphine and morphine metabolites either were not detectable after intrathecal morphine or were much lower after intrathecal morphine than after intravenous morphine. CONCLUSIONS: Depression of the ventilatory response to hypoxia after the administration of intrathecal morphine is similar in magnitude to, but longer-lasting than, that after the administration of an equianalgesic dose of intravenous morphine.     

Low-dose acetazolamide reduces the hypoxic ventilatory response in the anesthetized cat

Low intravenous dose acetazolamide causes a decrease in steady-state CO(2) sensitivity of both the peripheral and central chemoreflex loops. The effect, however, on the steady-state hypoxic response is unknown. In the present study, we measured the effect of 4 mg x kg(-1) acetazolamide (i.v.) on the isocapnic steady-state hypoxic response in anesthetized cats. Before and after acetazolamide administration, the eucapnic steady-state hypoxic response in these animals was measured by varying inspiratory P(O2) levels to achieve steady-state Pa(O2) levels between hyperoxia Pa(O2) approximately 55 kPa, approximately 412 mmHg) and hypoxia (Pa(O2) approximately 7 kPa, approximately 53 mmHg). The hypoxic ventilatory response was described by the exponential function V(I) = G exp (-DP(o2) + A with an overall hypoxic sensitivity G, a shape parameter D and ventilation during hyperoxia A. Acetazolamide significantly reduced G from 3.057 +/- 1.616 to 1.573 +/- 0.8361 min(-1) (mean +/- S D). Parameter A increased from 0.903 +/- 0.257 to 1.193 +/- 0.321 min(-1), while D remained unchanged. The decrease in overall hypoxic sensitivity by acetazolamide is probably mediated by an inhibitory effect on the carotid bodies and may have clinical significance in the treatment of sleep apneas, particularly those cases that are associated with an increased ventilatory sensitivity to oxygen and/or carbon dioxide.     

The ventilatory response to carbon dioxide and sustained hypoxia is enhanced after episodic hypoxia in OSA patients

Our primary hypothesis was that the acute ventilatory response to carbon dioxide in the presence of sustained hypoxia {VRCO2 (hypoxia)} or hyperoxia {VRCO2 (hyperoxia)} would increase in subjects with obstructive sleep apnea (OSA) after exposure to episodic hypoxia. Secondarily, we hypothesized that chronic (i.e. years) exposure to episodic hypoxia, a hallmark of OSA, would facilitate persistent augmentation of respiratory activity (i.e. long-term facilitation) after acute (i.e. minutes) exposure to episodic hypoxia. Nine healthy males with OSA that were healthy otherwise completed a series of rebreathing trials before and after exposure to eight 4 min episodes of hypoxia. On a separate occasion, the rebreathing trials were repeated before and after exposure to atmospheric air for a duration equivalent to the episodic hypoxia protocol (i.e. sham episodic hypoxia). During the rebreathing trials, subjects initially hyperventilated to reduce the partial pressure of carbon dioxide (P(ET)CO2) below 25 Torr. Subjects then rebreathed from a bag containing a normocapnic (42 Torr), low (50 Torr) or high oxygen gas mixture (140 Torr). During the trials, P(ET)CO2 increased while the selected level of oxygen was maintained. The point at which ventilation began to rise in a linear fashion as P(ET)CO2 increased was the ventilatory threshold. The ventilatory response below and above the threshold was determined. The results showed that the VRCO2 (hypoxia) and the VRCO2 (hyperoxia) was increased after exposure to episodic hypoxia {VRCO2 (hypoxia): 7.9 +/- 1.3 versus 10.5 +/- 1.3, VRCO2 (hyperoxia): 5.9 +/- 1.1 versus 6.7 +/- 1.1 L/min/Torr}. However, only the increase in the VRCO2 (hypoxia) after episodic hypoxia was greater than the increase measured after exposure to sham episodic hypoxia. Long-term facilitation of ventilation, tidal volume and breathing frequency was not evident after episodic hypoxia. We conclude that the VRCO2 (hypoxia) is enhanced after exposure to acute episodic hypoxia and that enhancement of the VRCO2 (hypoxia) occurs even though long-term facilitation is not evident.     

Changes of ventilation and ventilatory response to hypoxia during the menstrual cycle

The relationship between change in hypoxic sensitivity in respiration, defined as increment in ventilation per drop of arterial O₂ saturation , with the phase change from follicular to luteal and those in resting pulmonary ventilation , mean inspiratory flow (V _T/T _I), alveolar partial pressures of CO₂ and O₂ ( and , respectively) and body temperature was studied in 10 women. There was a significant relationship between % increase in hypoxic sensitivity and decrement of resting that occurred in the luteal phase. However, no significant relationships were observed between change in hypoxic sensitivity and those in the remaining parameters studied. The intersubject variation in % increase in resting during the luteal phase was not associated with that in % increase in hypoxic sensitivity. The results indicate that the contribution of increased hypoxic sensitivity to increasing during the luteal phase is variable among subjects. Reasons for the increase in hypoxic sensitivity with hypocapnia are discussed.     

Basilar artery blood flow velocity and the ventilatory response to acute hypoxia in mountaineers

Hypoxic ventilatory response is higher in successful extreme-altitude climbers than in controls. We hypothesized that these climbers have lower brainstem blood flow secondary to hypoxia which may possibly cause retention of medullary CO(2) and greater ventilatory drive. Using transcranial Doppler, basilar artery blood flow velocity (Vba) was measured at sea level in 7 extreme-altitude climbers and 10 controls in response to 10 min sequential exposures to inspired oxygen fractions (FI(O(2))) of 0.21 (baseline), 0.13, 0.11, 0.10, 0.09, 0.08 and 0.07. Sa(O(2)) was higher in climbers at FI(O(2)) of 0.11 (P<0.05), 0.08 and 0.07 (both P<0.0001). Expired ventilation (VE) increased more (n.s.), and PET(CO(2)) decreased more (n.s.) in the climbers than in controls. Vba did not significantly change in both groups at FI(O(2)) of 0.13-0.09. At FI(O(2)) of 0.08 and 0.07, Vba decreased 21% (P<0.03) and 27% (P<0.01), respectively, in climbers, and increased 29% (P<0.01) and 27% (P<0.01), respectively, in controls. The conflicting effects of hypoxia and hypocapnia on both medullary blood flow and ventilatory drive thus balance out, giving climbers a greater drive and higher Sa(O(2)), despite lower PET(CO(2)) and lower brain stem blood flow.     

Characterisation of the ventilatory response to hypoxia in a model of transgenic anemic mice

Both polycythemia and the increase in hypoxic ventilatory response (HVR) are considered as important factors of acclimatization to hypoxia. The objective of this study was to characterise the ventilation pattern at different inspired oxygen fraction in a model of chronic anemic mice. These mice have a targeted disruption in the 5' untranslated region of the Epo gene that reduces Epo expression such that the homozygous animal is severely anemic. Ventilation in normoxia in Epo-TAg(h) mice was significantly greater than in wild type, and the difference was mainly due to a higher tidal volume. HVR was higher in Epo-TAg(h) mice at every FIO2 suggesting a higher chemosensitivity. Resting oxygen consumption was maintained in anemic mice. Maximal oxygen consumption was 30% lower while hemoglobin was 60% lower in anemic mice compared to wild type. This small decrease in maximal oxygen consumption is probably due a greater cardiac output and/or a better tissue oxygen extraction and would allow these anemic mice to acclimatize to hypoxia in spite of low oxygen carrying capacity. In conclusion, Epo-TAg(h) anemic mice showed increased ventilation and hypoxic ventilatory response. However, whether these adaptations will contribute to acclimatization in chronic hypoxia remains to be determined.     

Glutamatergic receptors of the rostral ventrolateral medulla are involved in the ventilatory response to hypoxia

Rostral ventrolateral medulla (RVLM) is a region in the brainstem that is involved in the physiologic responses to hypoxia (i.e. hyperventilation and regulated hypothermia) and contains l-glutamate receptors. Therefore, we examined the effects of blocked of glutamatergic receptors in the RVLM on hypoxic hyperventilation and regulated hypothermia. Ventilation (V(E)) and body temperature (T(b)) were measured before and after bilaterally microinjection of kynurenic acid (KYN, 5 nmol/100 nl, an ionotropic glutamatergic receptors antagonist) and alpha-methyl-4-carboxyphenylglycine (MCPG, 10 nmol/100 nl, a metabotropic glutamatergic receptors antagonist) into the RVLM, followed by a 60-min period of hypoxia exposure. Control rats received microinjection of saline (vehicle). KYN or MCPG into the RVLM did not change V(E) and T(b) under normoxia, but reduced the hypoxic hyperventilation due to a lower tidal volume, although regulated hypothermia persisted. These data suggest that glutamatergic receptors in the RVLM are involved in the ventilatory response to hypoxia, exercising an excitatory modulation of the RVLM neurons, but play no role in hypoxia-induced hypothermia.     

Blunted ventilatory response to hypoxia/hypercapnia in mice with cigarette smoke-induced emphysema

It has been reported that the degree of emphysema induced by chronic cigarette smoke (CS) is greater in female C3H/HeN mice as compared to other mouse strains. We hypothesized that these mice would develop the similar major characteristics seen in hypercapnic patients with chronic obstructive pulmonary disease (COPD), including emphysema, pulmonary inflammation, hypercapnia/hypoxemia, rapid breathing, and attenuated ventilatory response (AVR). Mice were exposed either to CS or filtered air (FA) for 16 weeks. After exposure, arterial blood gases and minute ventilation were measured before and during chemical challenges in anesthetized and spontaneously breathing mice. We found that as compared to FA, CS exposure caused emphysema and pulmonary inflammation associated with: (1) hypercapnia and hypoxemia, (2) rapid breathing, and (3) AVR to 25 breaths of pure N(2), 5% CO(2) alone, and 5% CO(2) coupled with 10% O(2). The similarity of these pathophysiological characteristics between our mouse model and COPD patients suggests that this model could be effectively applied to study COPD pathophysiology, especially central mechanisms of the AVR genesis.     

Restoration of reflex ventilatory response to hypoxia after removal of carotid bodies in the cat

In mammals there are two sets of peripheral arterial chemoreceptors, the carotid bodies innervated by the sinus branch of the glossopharyngeal nerve and the aortic bodies innervated by the vagus nerves. The afferent impulse discharge from both receptors increases during hypoxia and there is a reflexly mediated increase in ventilation (hypoxic hyperventilation). In the present study we tested this response by exposing anesthetized cats to decreased inspired O₂ concentration before and up to 315 days after bilateral resection of the carotid bodies. Acutely after removing the carotid bodies, hypoxic hyperventilation was abolished. This observation supports the view that the reflex pathway from the aortic body receptors normally contributes minimally to hypoxic hyperventilation. Subsequently, there was a restoration of hypoxic hyperventilation. Restoration was significant 30–43 days after removing the carotid bodies, it reached 70% of the preoperative value at 93–111 days and was essentially complete in terminal experiments 260–315 days after carotid body resection. In terminal experiments, hypoxic hyperventilation was not affected by recutting the regenerated carotid sinus nerves but was abolished completely by bilateral transection of the cervical vagosympathetic trunks. The restored ventilatory response was due predominantly to an increase in rate of breathing while an increase in tidal volume was predominant before carotid body resection. Resting ventilation breathing room air was not consistently decreased after carotid body resection while expired CO₂ was elevated from day 20 to day 111 and at the preoperative level in terminal experiments.It is concluded that restoration of hypoxic hyperventilation in the cat after carotid body resection is mediated by the reflex pathway from aortic body chemoreceptors. The possible contribution of chemo-receptive regenerated carotid sinus nerve axons was excluded. It is suggested that restoration may be a consequence of the central reorganization of chemoreceptor afferent pathways consequent to interruption of the carotid body reflex pathway and that as a result the ‘gain’ of the aortic body ventilatory chemoreflex is enhanced.