Ventilatory long-term facilitation in non-snoring subjects during NREM sleep.

We hypothesized that very brief episodes of hypoxia (<1 min) would evoke long-term facilitation (LTF) in individuals free of inspiratory flow limitation (IFL). We studied 12 healthy participants who were self-reported non-snorers and confirmed the absence of IFL. We induced 15 brief episodes of hypoxia during non-REM sleep, reducing arterial oxygen saturation to 84-85%, followed by 1 min of room air. Ventilatory variables and resistance were measured during the control period, hypoxic trials, room air controls, and for 20 min following the last hypoxic episode. There was a significant increase in minute ventilation (108+/-1.3% of control, P < 0.05) and tidal volume (105+/-1.7% of control, P < 0.05) and a significant decrease in upper airway resistance (88+/-9.8% control, P < 0.05) during the recovery period. However, there were no significant changes in any variable during sham studies. We have shown for the first time that LTF can be elicited in sleeping humans free of IFL.

Respiratory control of hypoglossal motoneurones in the rat.

In this study of adult and neonatal rats, we used cross-correlation analysis to detect synchronous neuronal events in hypoglossal and phrenic nerves to infer synaptic connections. We found evidence for the common excitation of medial and lateral hypoglossal motoneurones in 12 anaesthetized adult rats but not in 6 in vitro brainstem-spinal cord preparations. We did not find evidence for the common activation of phrenic and hypoglossal motoneurones in 23 adult and 10 neonatal rat preparations. We confirmed this negative result by demonstrating that 26 medullary inspiratory neurones activating phrenic motoneurones did not activate hypoglossal motoneurones in 23 adult decerebrate rats (except in one case). We also found that 15 Bötzinger expiratory neurones inhibiting phrenic motoneurones did not inhibit hypoglossal motoneurones. We conclude that: (1) motoneurones of the medial and lateral hypoglossal nerve branches receive inspiratory drive from a common premotor population in adult rats, but in neonatal rats adjacent nerve rootlets do not; (2) in both adult and neonatal rats phrenic premotor neurones do not monosynaptically excite hypoglossal motoneurones; (3) Bötzinger expiratory neurones that inhibit phrenic motoneurones do not inhibit hypoglossal motoneurones. We therefore suggest that the respiratory control of hypoglossal motoneurones is separate from that of phrenic motoneurones.

Cardiorespiratory and autonomic interactions during snoring related resistive breathing.

STUDY OBJECTIVES: We hypothesized that blood pressure (BP) is less during snoring as compared to periods of non-snoring in non-apneic individuals. Furthermore, we hypothesized that this reduction may be accompanied by a simultaneous decrease in sympathetic (SNSA) and parasympathetic (PNSA) nervous system activity and an increase in heart rate (HR). DESIGN: N/A. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. MEASUREMENTS: The variables mentioned above in addition to breathing frequency were measured in 9 subjects during NREM sleep. In addition, the lowest systolic (SBP) and diastolic blood pressure (DBP) during inspiration and the highest SBP and DBP during expiration was determined breath-by-breath from segments selected from each NREM cycle. Heart rate variability was used as a marker of autonomic nervous system activity. RESULTS: Our results showed that BP during snoring decreased compared to non-snoring and the breath-by-breath BP analysis suggested that this difference may have been mediated by changes in intrathoracic pressure. In conjunction with the decrease in BP, SNSA decreased and HR increased however PNSA remained constant. Thus, a decrease in PNSA was likely not the primary mechanism responsible for the HR response. CONCLUSIONS: We conclude that BP responses and SNSA during snoring are similar to that reported previously in non-snoring individuals. However, the causal mechanisms maybe different and manifested in other measures such as HR. Thus, nocturnal cardiovascular and autonomic function maybe uniquely different in non-apneic snoring individuals.

Adaptive and dynamic control of respiratory and motor systems during object manipulation.

This investigation was designed to examine the relationship between breathing and prehension movements during object manipulation. Seated subjects (n=12) wore a facemask that was attached to a pneumotachometer which measured airflow. Initially, subjects completed baseline trials that were preceded and followed by an object lift. Subsequently, in response to an auditory signal the subjects reached forward, grasped and lifted an instrumented object that weighed either 150 g or 1000 g while their fingertip forces and movements were measured. The auditory signal was triggered by airflow in response to four experimental conditions (1) expiratory onset (2) inspiratory onset (3) mid-inspiration and (4) mid-expiration. Five trials for each of the four conditions were completed with each weight. The results revealed that inspiratory time was longer under baseline conditions after the subjects lifted the 150 g object as compared to the 1000 g object. In addition, the response latency and reach duration were significantly slower for the 150 g object compared to the 1000 g object during the experimental trials. These temporal measures were significantly correlated to inspiratory time for three of the four experimental conditions but no significant relationship with expiratory time was found. Lastly, lifting of the object occurred during expiration during most experimental conditions. We conclude that an adaptive process is formulated for both the motor and respiratory system in response to changes in motor output and/or sensory inputs associated with object manipulation, that might manifest itself in the pattern of breathing subsequent to removal of these stimuli. Furthermore, we suggest that motor inputs associated with the initiation of object manipulation interact with the control of respiratory timing so that the motor and respiratory systems are coupled. We speculate that this relationship may ensure that some motor tasks are performed during expiration to take advantage of changes in intrathoracic pressure that assist in postural maintenance during completion of the task.

Response of human tongue protrudor and retractors to hypoxia and hypercapnia.

It is well established that the genioglossus muscle (tongue protrudor) has a role in protecting or enhancing upper airway patency in individuals with obstructive sleep apnea. However, no investigation completed to date has addressed the role of the styloglossus and hyoglossus muscles (tongue retractors) in maintaining upper airway patency in humans. As a first step toward this goal, the present investigation was designed to examine the response of human tongue protrudor and retractor muscles during a breathhold maneuver and in steady-state hypoxic hypercapnia. The results showed that the protrudor and retractor muscles were coactivated under both conditions. Measurements of onset time of electromyographic activity during steady-state hypoxic hypercapnia revealed that phasic protrudor and retractor activity was initiated immediately before or during the early part of inspiration. We conclude that the tongue protrudor and retractor muscles are coactivated in response to hypoxia and hypercapnia, and that the tongue retractors may have a significant role in protecting upper airway patency during both apnea and hyperpnea.

Spontaneous baroreflex analysis in non-apneic snoring individuals during NREM sleep.

The primary purpose of this study was to measure baroreceptor sensitivity (BS) during wakefulness and non-rapid eye movement (NREM) sleep in non-apneic snoring individuals. To achieve this purpose continuous and simultaneous measurements of snoring, oxygen saturation, sleep stages, arterial blood pressure and heart rate were obtained from seven non-apneic snoring subjects. After obtaining these measures, a computer program was employed to detect concomitant increases or decreases in systolic blood pressure and R-R interval duration during sequences of three or more consecutive beats that occurred during stage II and slow wave sleep (SWS). The values recorded from a given sequence were plotted and the slope of the regression line fit to the data was used as a measure of BS. The results showed that mean arterial pressure and heart rate during stage II and SWS of NREM sleep were not significantly different from wakefulness. In contrast, the BS measured during NREM sleep was significantly lower than values recorded during wakefulness. In addition, linear regression analysis showed that an inverse and significant correlation existed between snoring frequency and the decrease in BS during sleep. We conclude that the decrease in blood pressure and heart rate normally observed during NREM sleep in healthy non-snoring individuals is attenuated or abolished in non-apneic snoring individuals and that these cardiovascular alterations may be partially mediated by a decrease in BS.

Co-activation of tongue protrudor and retractor muscles during chemoreceptor stimulation in the rat.

1. Our primary purpose was to test the hypothesis that the tongue protrudor (genioglossus, GG) and retractor (styloglossus, SG and hyoglossus, HG) muscles are co-activated when respiratory drive increases, and that co-activation will cause retraction of the tongue. This was addressed by performing two series of experiments using a supine, anaesthetized, tracheotomized rat in which tongue muscle force and the neural drive to the protrudor and retractor muscles could be measured during spontaneous breathing. In the first series of experiments, respiratory drive was increased progressively by occluding the tracheal cannula for thirty respiratory cycles; in the second series of experiments, the animals were subjected to hyperoxic hypercapnia and poikilocapnic hypoxia. 2. Airway occlusion for thirty breaths caused progressive, quantitatively similar increases in efferent motor nerve activity to protrudor and retractor tongue muscles. Net tongue muscle force was always consistent with tongue retraction during occlusion, and peak force rose in parallel with the neural activites. When airway occlusion was repeated following section of the lateral XIIth nerve branch (denervation of retractor muscles) the tongue either protruded (15/21 animals; 10 +/- 2 mN at the 30th occluded breath) or retracted weakly (6/21 animals; 6 +/- 2 mN at 30th occluded breath). 3. To ensure that our findings were not the result of damage to the muscle nerves, occlusion experiments were also done in eight animals in which GG EMG activity was recorded instead of nerve activities. Changes in peak integrated GG electryomyogram (EMG) activity and peak retraction force during occlusion were highly correlated (r2 = 0.86, slope = 1.05). 4. In separate experiments in fourteen rats, we found that hyperoxic hypercapnia and poikilocapnic hypoxia also result in parallel increases in the respiratory-related EMG activity of the GG and HG muscles. Also, as in the occlusion experiments, augmentations of protrudor and retractor muscle EMG activities were associated with parallel changes in tongue retraction force. 5. These studies in anaesthetized rats demonstrate that tracheal occlusion and independent stimulation of central or peripheral chemoreceptors results in inspiratory-related co-activation of the protrudor and retractor muscles, and proportional changes in tongue retraction force. These observations also demonstrate that recording GG EMG activity in isolation could lead to erroneous conclusions about respiratory-related movements of the tongue.

Contractile properties of human nasal dilator motor units.

The technique of intramuscular microstimulation was used to activate facial nerve fibers while acquiring simultaneous twitch force measurements to measure the contractile properties and force-frequency responses of human nasal dilator (ND) motor units. Twitch force amplitude (TF), contraction time (CT), half-relaxation time (HRT), and the maximal rate of rise of force normalized to the peak force (maximum contraction rate, MCR) were recorded from 98 ND motor units in 37 subjects. The average CT, HRT, MCR, and TF were 47.9 +/- 1.8 ms, 42.6 +/- 2.1 ms, 28.6 +/- 1.8 s-1, and 1.06 +/- 0.1 mN, respectively. Neither CT nor HRT were significantly correlated with TF. The average CT and HRT were similar to values recorded for small muscles of the hand but were faster than the values recorded from human toe extensor motor units. However the lack of an association between twitch force and CT or HRT was similar to the findings obtained for both human hand and foot muscles. Force-frequency curves were recorded from eight ND motor units. The force produced by the eight motor units was recorded in response to stimuli delivered at 1, 5, 10, 15, 20, 25, 30, 35, and 40 Hz to assess force-frequency relationships. The mean twitch force of the eight motor units was 0.91 +/- 0.3 mN and the average tetanic force was 8.1 +/- 1.8 mN. Therefore the average twitch force was equal to 12.7% of the tetanic force. Fifty percent of the unit tetanic force was achieved at an average frequency of 16. 4 +/- 1.7 Hz, which is greater than the value recorded for human toe extensor motor units (9.6 Hz). Thus the force produced by the ND motor units was more sensitive to changes in discharge frequency over the range of approximately 10-30 Hz and less sensitive to changes in the range of 0-10 Hz because of their fast contractile properties. The mean slope of the regression lines that were fit to the steep portion of each force-frequency curve was 5.15 +/- 0.5% change in force/Hz. This value was greater than the slope measured for human toe extensor muscles (4.2% change in force/Hz). These observations suggest that force gradation by ND motor units is more sensitive to changes in stimulation frequency than human toe extensor motor units. We conclude that most ND motor units have fast contractile properties and that rate coding may play a significant role in the gradation of force produced by the ND muscle. Furthermore, the findings of this investigation have demonstrated that contractile speed and TF in a human facial muscle are not correlated. This supports previous findings obtained from human hand and foot muscles and suggests that there may be a fundamental difference in the contractile speed-twitch force relationship between many human muscles and most muscles of other mammals.

Long-term facilitation of upper airway muscle activities in vagotomized and vagally intact cats.

The primary purpose of the present investigation was to determine whether long-term facilitation (LTF) of upper airway muscle activities occurs in vagotomized and vagally intact cats. Tidal volume and diaphragm, genioglossus, and nasal dilator muscle activities were recorded before, during, and after one carotid sinus nerve was stimulated five times with 2-min trains of constant current. Sixty minutes after stimulation, nasal dilator and genioglossus muscle activities were significantly greater than control in the vagotomized cats but not in the vagally intact cats. Tidal volume recorded from the vagotomized and vagally intact cats was significantly greater than control during the poststimulation period. In contrast, diaphragm activities were not significantly elevated in the poststimulation period in either group of animals. We conclude that 1) LTF of genioglossus and nasal dilator muscle activities can be evoked in vagotomized cats; 2) vagal mechanisms inhibit LTF in upper airway muscles; and 3) LTF can be evoked in accessory inspiratory muscles because LTF of inspired tidal volume was greater than LTF of diaphragm activity.

Effect of hypoxia on abdominal motor unit activities in spontaneously breathing cats.

These experiments were designed to examine the behavior of external oblique motor units in spontaneously breathing cats during hypoxia and to estimate the contribution of recruitment and rate coding to changes in the integrated external oblique electromyogram (iEMG). Motor unit activities in the external oblique muscle were identified while the cats expired against a positive end-expiratory pressure (PEEP) of 1-2.5 cmH2O. After localization of unit activity, PEEP was removed, and recordings were made continuously for 3-4 min during hyperoxia, normoxia, and hypoxia. A total of 35 single motor unit activities were recorded from 10 cats. At each level of fractional concentration of end-tidal O2, the motor unit activity was characterized by an abrupt increase in mean discharge frequency, at approximately 30% of expiratory time, which then continued to increase gradually or remained constant before declining abruptly at the end of expiration. The transition from hyperoxia to normoxia and hypoxia was accompanied by an increase in the number of active motor units (16 of 35, 20 of 35, and 29 of 35, respectively) and by an increase in the mean discharge frequency of those units active during hyperoxia. The changes in motor unit activity recorded during hypoxia were accompanied by a significant increase in the average peak amplitude of the abdominal iEMG. Linear regression analysis revealed that motor unit rate coding was responsible for close to 60% of the increase in peak iEMG amplitude. The changes in abdominal motor unit activity and the external oblique iEMG that occurred during hypoxia were abolished if the arterial PCO2 was allowed to fall. We conclude that external oblique motor units are activated during the latter two-thirds of expiration and that rate coding and recruitment contribute almost equally to the increase in expiratory muscle activity that occurs with hypoxia. In addition, the excitation of abdominal motor units during hypoxia is critically dependent on changes in CO2 and/or tidal volume.

A review of the control of breathing during exercise.

During the past 100 years many experimental investigations have been carried out in an attempt to determine the control mechanisms responsible for generating the respiratory responses observed during incremental and constant-load exercise tests. As a result of these investigations a number of different and contradictory control mechanisms have been proposed to be the sole mediators of exercise hyperpnea. However, it is now becoming evident that none of the proposed mechanisms are solely responsible for eliciting the exercise respiratory response. The present-day challenge appears to be one of synthesizing the proposed mechanisms, in order to determine the role that each mechanism has in controlling ventilation during exercise. This review, which has been divided into three primary sections, has been designed to meet this challenge. The aim of the first section is to describe the changes in respiration that occur during constant-load and incremental exercise. The second section briefly introduces the reader to traditional and contemporary control mechanisms that might be responsible for eliciting at least a portion of the exercise ventilatory response during these types of exercise. The third section describes how the traditional and contemporary control mechanisms may interact in a complex fashion to produce the changes in breathing associated with constant-load exercise, and incorporates recent experimental evidence from our laboratory.

The ventilation, lactate and electromyographic thresholds during incremental exercise tests in normoxia, hypoxia and hyperoxia.

These experiments examined the effect of hypoxia and hyperoxia on ventilation, lactate concentration and electromyographic activity during an incremental exercise test in order to determine if coincident chances in ventilation and electromyographic activity occur during an incremental exercise test, despite an enhancement or reduction of peripheral chemoreceptor activity. In addition, these experiments were completed to determine if electromyographic activity and ventilation are enhanced or reduced in response to the inspiration of oxygen-depleted and oxygen-enriched air, respectively. Seven subjects performed three incremental exercise tests, until volitional exhaustion was achieved, while inspiring air with a fractional concentration of oxygen of either 66%, 21% or 17%. In addition, another single subject completed two tests while inspiring air with a fractional concentration of either 17% or 21%. During the tests, ventilation, mixed expired oxygen and carbon dioxide, arterialized venous blood and the electromyographic activity from the vastus lateralis were sampled. From these values ventilation, electromyographic and lactate thresholds were detected during normoxia, hypoxia and hyperoxia. The results showed that although ventilation and lactate concentration were significantly less during hyperoxia as compared to normoxia or hypoxia, the carbon dioxide production values were not significantly different between the normoxic, hypoxic and hyperoxic conditions. For a particular condition, the time, carbon dioxide production and oxygen consumption values that corresponded to the ventilation and electromyographic thresholds were not significantly different, but the values corresponding to the lactate threshold were significantly less than those for the electromyographic and ventilation thresholds. Comparisons between the three conditions showed that the time, carbon dioxide production and oxygen consumption values corresponding to each of these thresholds were not significantly difficult.(ABSTRACT TRUNCATED AT 250 WORDS)

Ventilatory responses to exercise performed below and above the first ventilatory threshold.

These experiments examined the changes in ventilation at the start and end of exercise. Six subjects walked on a treadmill at two work rates above and two below that corresponding to their first ventilatory thresholds, for three durations. The subjects also exercised at the lowest and highest work rates while inspiring oxygen-enriched air. The group mean results showed that the abrupt increases in ventilation at the start of exercises at work rates above that of the first ventilatory threshold were greater than those below, but did not vary with duration or work rate either above or below. The abrupt falls in ventilation at the end of the exercises were less than the increases at the start. At work rates above that of the first ventilatory threshold, increases in work rate and duration were found to reduce the abrupt falls. The time constants of exponential curves fitted to the post-exercise declines in ventilation increased with work rate, and also with duration for work rates above that of the first ventilatory threshold. Finally, breathing oxygen enriched air did not alter any of these variables. These findings were interpreted as showing that the fast neural exercise drive is enhanced at work rates above that of the first ventilatory threshold, and becomes progressively less as exercise continues, a process exaggerated at higher work rates. In addition, the time course of the decline in ventilation following exercise, although altered by work rate and duration, was independent of the level of oxygenation.

Coincidental changes in ventilation and electromyographic activity during consecutive incremental exercise tests.

These experiments examined the effect of metabolic acidosis, induced as a result of dynamic exercise, on ventilation, lactate concentration and electromyographic activity. Seven subjects performed two consecutive incremental exercise tests until volitional exhaustion was achieved. The two tests were identical and were separated by a 7-min period of light exercise. During the tests, ventilation, mixed expired oxygen and carbon dioxide, arterialized venous blood and electromyographic activity from the vastus lateralis was sampled. The results showed that the ventilation and electromyographic measurements followed a similar time course during both tests, although ventilation during the initial 6 min of the second test was significantly greater than the values recorded during the first test. In addition, throughout the first test lactate concentration increased with time, and pH, bicarbonate concentration and partial pressure of carbon dioxide decreased. In contrast, during the second test, lactate concentration decreased, and pH and bicarbonate concentration increased; during a period of time when ventilation and electromyographic activity were increasing. These findings have led us to conclude that changes in ventilation and electromyographic activity observed during incremental exercise are not related to changes in blood lactate concentration. It is suggested that such a conclusion supports the hypothesis that the changes in ventilation are mediated by an increase in neural activity originating from the subthalamic motor region or exercising limbs, induced in response to the need to progressively recruit fast twitch muscle fibres as exercise work rate is increased and as individual muscle fibres begin to fatigue.

Evening-to-morning blood pressure variations in snoring patients with and without obstructive sleep apnea.

This study was designed to test a hypothesis that patients with sleep apnea have higher blood pressure in the morning, following a night spent in apnea and hypoxemia, than in the evening. To accomplish this, we prospectively studied a set of 611 patients referred to our clinic because of suspicion of sleep apnea. All patients had full nocturnal polysomnography, including measurement of snoring. Blood pressure was measured in the evening, prior to onset of sleep, and in the morning, immediately on awakening. We found that patients without apnea and hypoxemia had lower blood pressure in the morning compared with the evening value, while patients with severe sleep apnea and hypoxemia had higher blood pressure in the morning; these evening-to-morning blood pressure differences, although statistically significant, were small, typically 1 to 4 mm Hg. Morning blood pressures were higher in patients with sleep apnea and hypoxemia than in nonapneic normoxic patients. However, this difference disappeared after the groups were matched for age and body mass index. We conclude that (1) patients with sleep apnea and nocturnal hypoxemia lose the expected morning dip in arterial blood pressure, and (2) age and body mass index are more important correlates of blood pressure than apnea and nocturnal oxygen desaturation. We speculate that the loss of evening-to-morning drop in blood pressure, if present over a long period of time, may lead to sustained elevations in arterial blood pressure frequently observed in patients with sleep apnea.

Changes in ventilation at the start and end of moderate and heavy exercise of short and long duration.

These experiments examined the effect of exercise intensity and duration on the magnitude of the abrupt change in ventilation at the start (VE,start) and end (VE,end) of exercise. Five subjects performed constant load treadmill exercise at 50% and 80% of their maximum oxygen consumption (VO2max) for 6 and 10 min while inspiring atmospheric air. The subjects also completed additional exercise tests at 80% VO2max for 10 min while inspiring an oxygen-enriched gas mixture. During each exercise trial ventilation was measured breath-by-breath. The VE,start and VE,end were determined by using non-linear curve-fitting techniques. The results showed that VE,start was greater at the start of the 80-% exercise tests compared to the 50-% tests and that VE,start at each level of exercise was greater than VE,end. The results also demonstrated that VE,end was inversely related to the intensity and duration of exercise. Furthermore, the VE,end was not altered subsequent to the inspiration of oxygen-enriched air. These findings have led us to postulate that the stimulus responsible for VE,start is reduced during exercise and that the degree of reduction is related to the intensity and duration of exercise. In addition, it was concluded that these changes might occur independently of peripheral chemoreceptor activity.

The effect of snoring on mean arterial blood pressure during non-REM sleep.

The purpose of this study was to examine the relationship between snoring and mean arterial blood pressure during sleep. This was accomplished by performing continuous, all-night, simultaneous measurements of snoring, oxygen saturation, sleep stages, and arterial blood pressure in a group of eight snorers and five nonsnoring control subjects. The results were analyzed to determine whether changes in mean arterial blood pressure during non-rapid-eye-movement (non-REM) sleep are different in snorers from those in nonsnorers and whether they are related to nocturnal hypoxemia. Both groups were similar with respect to their anthropometric parameters and sleep architecture. Oxygen saturations during different stages of non-REM sleep were similiar within each group. However, the analysis of variance revealed that among snorers mean arterial blood pressure increased slightly during slow-wave sleep, whereas the nonsnorers reduced their blood pressure by 17.4 +/- 3.7% compared with wakefulness values. We also performed multiple linear regression analysis for the entire group of 13 subjects using the change in mean arterial blood pressure relative to wakefulness as the dependent variable and snoring frequency and mean arterial oxygen saturation as the independent variables; the results demonstrated that only snoring frequency, and not oxygen saturation, correlated significantly with the change in mean arterial blood pressure. We conclude that snoring may influence variation of blood pressure during sleep, preventing the normally observed reduction of arterial blood pressure associated with slow-wave sleep.

Snoring and sleep architecture.

The purpose of this study was to examine whether snoring adversely affects sleep architecture and sleep efficiency, and thus may account for the frequent complaints of daytime tiredness and fatigue expressed by heavy snorers. We recruited eight self-confessed heavy snorers and six self-confessed nonsnorers. All subjects had full nocturnal polysomnography, including continuous monitoring of snoring, which was quantified by counting the number of snores per hour of sleep (snoring index), the number of snores per minute of snoring time (snoring frequency), maximal and mean nocturnal sound intensity (dBmax and dBmean, respectively). We found that even the self-confessed nonsnorers snored lightly, with significantly smaller frequency and index than the heavy snorers. Sleep architecture was similar in both groups. Distribution of snoring among the sleep stages differed for light and heavy snorers: light snorers snored uniformly throughout all sleep stages, whereas heavy snorers tended to snore more during slow-wave and REM sleep. Snoring frequency and snoring index were similar during all sleep stages in light snorers, but they were higher during slow-wave sleep in heavy snorers. Wakefulness time after sleep onset and sleep efficiency correlated significantly with the snoring index. We conclude that although snoring does not affect sleep architecture in general, it influences sleep efficiency and wakefulness time after sleep onset; this may have an adverse effect on daytime function of heavy snorers.

Daytime hypercapnia in the development of nocturnal hypoxemia in COPD.

Arterial oxyhemoglobin saturation (SaO2) falls to a variable extent during sleep in patients with COPD. These nocturnal falls in SaO2 may contribute to the development of pulmonary hypertension, nocturnal cardiac arrhythmias, and death during sleep. In order to determine which physiologic factors measured during wakefulness might contribute to the development of nocturnal hypoxemia, we performed multiple stepwise linear regression analyses in 48 patients with stable COPD with mean and lowest nocturnal SaO2 as dependent variables. It was concluded that the two chief variables, measured while awake, which are associated with alterations in nocturnal oxygenation in patients with COPD are baseline awake SaO2 and PaCO2. Hypercapnia appears to be a risk factor for the development of nocturnal hypoxemia in patients who are normoxic while awake.

The connections from botzinger expiratory neurons to upper cervical inspiratory neurons in the cat.

These experiments examined possible inhibitory inputs to upper cervical inspiratory neurons from the expiratory neurons of the Botzinger complex. Eighty-one Botzinger neurons were tested with antidromic mapping for a projection to the C1 segment of the spinal cord; 44/81 (54%) were found to project, 27/79 (34%) contralaterally, 17/68 (25%) ipsilaterally, and 1/66 (2%) both contralaterally and ipsilaterally. Antidromic mapping in contralateral C1 demonstrated the presence of a collateral in 3/15 (20%) of the Botzinger neurons tested, while 3/9 (33%) had collateral arborizations in ipsilateral C1. The collaterals mapped were not localized to the region of the upper cervical inspiratory neurons. Microstimulation in C3 (12-17 microA, 0.2-ms duration) at locations which produced short-latency (2.7-3.5 ms) inhibition of phrenic nerve discharge resulted in the short latency (3.0 ms) inhibition of 1/27 (3.7%) upper cervical inspiratory neurons as demonstrated by cross-correlation. It was concluded that while some upper cervical inspiratory neurons may be inhibited during expiration by the Botzinger expiratory neurons, this connection is not a strong one.