1 Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy.
2 Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Ann Am Thorac Soc. 2017 Jul;14(Supplement_1):S116-S122. doi: 10.1513/AnnalsATS.201701-003FR.
Periodic breathing during incremental cardiopulmonary exercise testing is a regularly recurring waxing and waning of tidal volume due to oscillations in central respiratory drive. Periodic breathing is a sign of respiratory control system instability, which may occur at rest or during exercise. The possible mechanisms responsible for exertional periodic breathing might be related to any instability of the ventilatory regulation caused by: (1) increased circulatory delay (i.e., circulation time from the lung to the brain and chemoreceptors due to reduced cardiac index leading to delay in information transfer), (2) increase in controller gain (i.e., increased central and peripheral chemoreceptor sensitivity to arterial partial pressure of oxygen and of carbon dioxide), or (3) reduction in system damping (i.e., baroreflex impairment). Periodic breathing during exercise is observed in several cardiovascular disease populations, but it is a particularly frequent phenomenon in heart failure due to systolic dysfunction. The detection of exertional periodic breathing is linked to outcome and heralds worse prognosis in heart failure, independently of the criteria adopted for its definition. In small heart failure cohorts, exertional periodic breathing has been abolished with several dedicated interventions, but results have not yet been confirmed. Accordingly, further studies are needed to define the role of visceral feedbacks in determining periodic breathing during exercise as well as to look for specific tools for preventing/treating its occurrence in heart failure.
在递增心肺运动试验中，周期性呼吸是由于中枢呼吸驱动的振荡导致潮气量周期性的增减。周期性呼吸是呼吸控制系统不稳定的标志，可能发生在休息时或运动时。导致运动性周期性呼吸的可能机制与任何由以下原因引起的通气调节不稳定有关：（1）循环延迟增加（即由于心指数降低导致从肺部到大脑和化学感受器的循环时间延长，从而导致信息传递延迟）；（2）控制器增益增加（即中枢和外周化学感受器对动脉血氧分压和二氧化碳分压的敏感性增加）；或（3）系统阻尼降低（即压力反射受损）。在几种心血管疾病人群中观察到运动性周期性呼吸，但由于收缩功能障碍，心力衰竭中是一种特别常见的现象。运动性周期性呼吸的检测与预后相关，并预示心力衰竭预后更差，与用于定义其的标准无关。在较小的心力衰竭队列中，已经通过几种专门的干预措施消除了运动性周期性呼吸，但结果尚未得到证实。因此，需要进一步研究以确定内脏反馈在决定运动时周期性呼吸中的作用，并寻找预防/治疗心力衰竭中周期性呼吸发生的特定工具。
