Shea S A
Harvard Medical School, Neuroendocrine, Circadian and Sleep Disorders Section, Brigham and Women's Hospital, Boston, MA 02115, USA.
Respir Physiol. 1997 Nov;110(2-3):199-210. doi: 10.1016/s0034-5687(97)00084-4.
In healthy humans ventilatory chemoreception results in exquisite regulation of arterial blood gases during NREM sleep, but during wakefulness other behavioral and arousal-related influences on breathing compete with chemoreceptive respiratory control. This paper examines the extent of chemoreceptive control of breathing within the normal physiological range in awake and sleeping humans and explores the consequences upon breathing of absent chemoreceptive function. Recent studies of subjects with congenital central hypoventilation syndrome (CCHS) demonstrate the extent of behavioral and arousal-related influences on breathing in the absence of arterial blood gas homeostasis. CCHS subjects lack chemoreceptor control of breathing and seriously hypoventilate during NREM sleep, requiring mechanical ventilation. Many CCHS subjects breathe adequately during many waking behaviors associated with arousal, cognitive activity or exercise--presumably reflecting input to the brainstem respiratory complex from the reticular activating system, the forebrain or mechanoreceptor afferents. In most situations, and despite changes in metabolism, the non-chemoreceptive inputs to breathing result in surprisingly well controlled arterial blood gases in CCHS patients.
在健康人体中，通气化学感受在非快速眼动睡眠期间能精确调节动脉血气，但在清醒状态下，其他与行为和觉醒相关的呼吸影响因素会与化学感受性呼吸控制相互竞争。本文研究了清醒和睡眠状态下人类在正常生理范围内呼吸的化学感受性控制程度，并探讨了化学感受功能缺失对呼吸的影响。最近对先天性中枢性低通气综合征（CCHS）患者的研究表明，在缺乏动脉血气稳态的情况下，行为和觉醒相关因素对呼吸的影响程度。CCHS患者缺乏呼吸的化学感受器控制，在非快速眼动睡眠期间严重通气不足，需要机械通气。许多CCHS患者在与觉醒、认知活动或运动相关的许多清醒行为中呼吸正常——这可能反映了来自网状激活系统、前脑或机械感受器传入神经向脑干呼吸复合体的输入。在大多数情况下，尽管代谢发生了变化，但CCHS患者呼吸的非化学感受性输入仍能使动脉血气得到令人惊讶的良好控制。
