Taytard Jessica, Niérat Marie-Cécile, Gand Camille, Lavault Sophie, Morélot-Panzini Capucine, Patout Maxime, Serresse Laure, Wattiez Nicolas, Bodineau Laurence, Straus Christian, Similowski Thomas
Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Armand-Trousseau, Service de Pneumologie Pédiatrique, Paris, France.
ERJ Open Res. 2023 Mar 13;9(2). doi: 10.1183/23120541.00408-2022. eCollection 2023 Mar.
Human mutations result in life-threatening sleep-related hypoventilation (congenital central hypoventilation syndrome, CCHS). Most patients retain ventilatory activity when awake through a respiratory-related cortical network. We hypothesised that this need to mobilise cortical resources to breathe would lead to breathing-cognition interferences during cognitive loading.
Seven adult CCHS patients (five women; median age 21) performed standard neuropsychological tests (paced auditory serial addition test - calculation capacity, working memory, sustained and divided attention; trail making test - visuospatial exploration capacity, cognitive processing speed, attentional flexibility; Corsi block-tapping test - visuospatial memory, short-term memory, working memory) during unassisted breathing and under ventilatory support. Ventilatory variables and transcutaneous haemoglobin oxygen saturation were recorded. Cortical connectivity changes between unassisted breathing and ventilatory support were assessed using electroencephalographic recordings (EEG).
Baseline performances were lower than expected in individuals of this age. During unassisted breathing, cognitive loading coincided with increased breathing variability, and decreases in oxygen saturation inversely correlated with an increasing number of apnoeic cycles per minute (rho -0.46, 95% CI -0.76 to -0.06, p=0.01). During ventilatory support, cognitive tasks did not disrupt breathing pattern and were not associated with decreased oxygen saturation. Ventilatory support was associated with changes in EEG cortical connectivity but not with improved test performances.
Acute cognitive loads induce oxygen desaturation in adult CCHS patients during unassisted breathing, but not under ventilatory support. This justifies considering the use of ventilatory support during mental tasks in CCHS patients to avoid repeated episodes of hypoxia.
人类突变会导致危及生命的睡眠相关通气不足（先天性中枢性通气不足综合征，CCHS）。大多数患者在清醒时通过与呼吸相关的皮质网络保持通气活动。我们假设，这种调动皮质资源进行呼吸的需求会导致认知负荷期间呼吸与认知的相互干扰。
7名成年CCHS患者（5名女性；中位年龄21岁）在自主呼吸和通气支持下进行标准神经心理学测试（听觉连续加法测试——计算能力、工作记忆、持续和分散注意力；连线测验——视觉空间探索能力、认知处理速度、注意力灵活性；科西方块敲击测试——视觉空间记忆、短期记忆、工作记忆）。记录通气变量和经皮血红蛋白氧饱和度。使用脑电图记录（EEG）评估自主呼吸和通气支持之间的皮质连接变化。
该年龄个体的基线表现低于预期。在自主呼吸期间，认知负荷与呼吸变异性增加同时出现，氧饱和度下降与每分钟呼吸暂停周期数增加呈负相关（rho -0.46，95%CI -0.76至-0.06，p = 0.01）。在通气支持期间，认知任务未扰乱呼吸模式，也与氧饱和度下降无关。通气支持与EEG皮质连接变化有关，但与测试表现改善无关。
急性认知负荷在自主呼吸期间会导致成年CCHS患者出现氧饱和度下降，但在通气支持下不会。这证明在CCHS患者进行心理任务期间使用通气支持以避免反复出现缺氧发作是合理的。
