Sleeping and breathing.

Breathing is controlled by an automatic brain-stem controller acted on by higher neural influences that stabilize breathing and compensate for neuromechanical abnormalities. Loss of this wakefulness-dependent descending influences during nonrapid eye movement (NREM) sleep results in the appearance of a hypocapnic apnea threshold, which is associated with periodic breathing when the gain of chemical feedback loops is high. In addition, loss of the descending wakefulness influence leads to loss of motor compensation that results in a rise in upper airway resistance, obstructive sleep apnea or hypoventilation in patients with kyphoskoliosis or thoracic neuromuscular disorders. REM sleep poses different problems for the respiratory control system owing to muscular atomia and suppression of chemical feedback. These changes are associated with respiratory deterioration in patients with compromised diaphragmatic function, eg, patients with chronic obstructive pulmonary disease.