Dept of Medicine, Queen's University, Kingston, ON, Canada.
Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada.
Eur Respir Rev. 2022 Sep 20;31(165). doi: 10.1183/16000617.0069-2022. Print 2022 Sep 30.
Sleep brings major challenges for the control of ventilation in humans, particularly the regulation of arterial carbon dioxide pressure ( ). In patients with COPD, chronic hypercapnia is associated with increased mortality. Therefore, nocturnal high-level noninvasive positive-pressure ventilation (NIV) is recommended with the intention to reduce down to normocapnia. However, the long-term physiological consequences of "correction" on the mechanics of breathing, gas exchange efficiency and resulting symptoms ( dyspnoea) remain poorly understood. Investigating the influence of sleep on the neural drive to breathe and its translation to the mechanical act of breathing is of foremost relevance to create a solid rationale for the use of nocturnal NIV. In this review, we critically discuss the mechanisms by which sleep influences ventilatory neural drive and mechanical consequences in healthy subjects and hypercapnic patients with advanced COPD. We then discuss the available literature on the effects of nocturnal NIV on ventilatory neural drive and respiratory mechanics, highlighting open avenues for further investigation.
睡眠给人体通气控制带来了重大挑战，尤其是动脉血二氧化碳分压（）的调节。在 COPD 患者中，慢性高碳酸血症与死亡率增加有关。因此，建议夜间使用高水平无创正压通气（NIV），目的是将降至正常碳酸血症。然而，“纠正”对呼吸力学、气体交换效率和由此产生的症状（呼吸困难）的长期生理后果仍知之甚少。研究睡眠对呼吸神经驱动的影响及其转化为机械呼吸动作的影响对于为夜间 NIV 的使用提供坚实的理论基础至关重要。在这篇综述中，我们批判性地讨论了睡眠影响健康受试者和晚期 COPD 高碳酸血症患者通气神经驱动和机械后果的机制。然后，我们讨论了关于夜间 NIV 对通气神经驱动和呼吸力学影响的现有文献，强调了进一步研究的开放途径。
