Siegel J M, Tomaszewski K S, Fahringer H, Cave G, Kilduff T, Dement W C
Neurobiology Research, Sepulveda Veterans Administration Medical Center, California 91343.
Am J Physiol. 1989 Jan;256(1 Pt 2):H111-9. doi: 10.1152/ajpheart.1989.256.1.H111.
Cataplexy is the abrupt loss of muscle tone experienced by narcoleptics. It is usually precipitated by strong emotions or athletic activity. It has been hypothesized that cardiovascular variables have a role in the triggering of cataplexy. In the present study, we have utilized the narcoleptic canine model to directly investigate changes in heart rate and blood pressure in relation to cataplectic episodes. We found that heart rate increased 18% on average in the 20 s preceding cataplexy onset and then fell during cataplexy. Thus, from a cardiovascular standpoint, cataplexy can be subdivided into two very different periods, the cataplexy onset period with very high and declining heart rate, and the period greater than or equal to 10 s after onset, with greatly reduced heart rate. Heart rate at cataplexy onset was significantly higher than heart rate in rapid-eye-movement (REM) sleep, non-REM sleep, and quiet waking. Blood pressure did not markedly change before the onset of spontaneous cataplexies but decreased significantly during cataplexy. Although blood pressure increases did not precede spontaneous cataplexies, sudden increases in blood pressure, induced pharmacologically or by obstruction of the descending aorta, triggered cataplexy in the most severely affected subjects. A hypothesized role for cataplexy as a homeostatic reflex, triggered by interactions between blood flow, central chemoreceptors, and atonia control mechanisms in the medial medulla, is discussed.
猝倒症是发作性睡病患者所经历的肌肉张力突然丧失。它通常由强烈情绪或体育活动诱发。据推测,心血管变量在猝倒症的触发中起作用。在本研究中,我们利用发作性睡病犬模型直接研究与猝倒发作相关的心率和血压变化。我们发现,在猝倒发作前20秒,心率平均增加18%,然后在猝倒期间下降。因此,从心血管角度来看,猝倒症可分为两个非常不同的时期,猝倒发作期心率非常高且下降,发作后10秒及以上时期心率大幅降低。猝倒发作时的心率显著高于快速眼动(REM)睡眠、非REM睡眠和安静觉醒时的心率。在自发猝倒发作前血压没有明显变化,但在猝倒期间显著下降。虽然血压升高在自发猝倒发作前并未出现,但在最严重受影响的受试者中,药理学诱导或降主动脉阻塞引起的血压突然升高会触发猝倒症。本文还讨论了猝倒症作为一种稳态反射的假设作用,它由血流、中枢化学感受器和延髓内侧无张力控制机制之间的相互作用触发。