Table Of ContentControl of Breathing
During Sleep and
Anesthesia
Control of Breathing
During Sleep and
Anesthesia
Edited by
W. A. Karczewski
P. Grieb and
Joanna Kulesza
Polish Academy of Sciences
Warsaw, Poland
and
G. Bonsignore
University of Palermo
Palermo, Italy
Springer Science+ Business Media, LLC
Library of Congress Cataloging in Publication Data
International Symposium on Control of Breathing during Sleep and Anesthesia (1987:
Warsaw, Poland)
Control of breathing during sleep and anesthesia / edited by Witold A. Karczewski
... [et al.]
p. cm.
"Proceedings of the International Symposium on Control of Breathing during Sleep
and Anesthesia, held September 10-12, 1987, in Warsaw, Poland" - T.p. verso.
Indudes bibliographies and index.
ISBN 978-1-4757-9852-4 ISBN 978-1-4757-9850-0 (eBook)
DOI 10.1007/978-1-4757-9850-0
1. Sleep apnea syndromes-Congresses. 2. Respiration-Regulation-Congresses. 3.
Anesthesia-Congresses. 4. Lungs-Diseases, Obstructive-Congresses. 1. Karczewski,
Witold A. II. Title. [DNLM: 1. Anesthesia-congresses. 2. Respiration-drug effects-
congresses. 3. Respiratory System-physiology-congresses. 4. Sleep-drug effects-
congresses. 5. Sleep-physiology-congresses. 6. Sleep Apnea Syndromes-congresses.
WF 102 1612c 1987]
RC737.5.157 1987
616.2-dcI9
DNLM/DLC 88-19689
for Library of Congress CIP
Proceedings of the International Symposium on Control of Breathing
during Sleep and Anesthesia, held September 10-12, 1987,
in Warsaw, Poland
© 1988 Springer Science+Business Media New York
Originally published by Plenurn Press, New York in 1988
Softcover reprint of the hardcover 1s t edition 1988
AII rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permis sion from the Publisher
PREFACE
Contrary to the popular belief, "Le sommeil n'est plus milieu s(lr"
(J. Cocteau, cf. Cl. Gaultier, Pathologie respiratoire du sommeil, La
Presse Medicale, 16, 561-563, 1987), and anesthesia is even less safe.
Sudden Infant Death Syndrome, Obstructive Sleep Apnea, Ondine's Curse and
various respiratory complications of general anesthesia are not so rare;
as a matter of fact they happen much too frequently.
The idea of organizing another symposium dealing with breathing in
sleep and anesthesia has been discussed almost immediately after we said
"good bye" to the Organizers of the excellent Paris meeting "The
Regulation of Respiration during Sleep and Anesthesia" (R.S. Fitzgerald,
H. Gautier, S. Lahiri eds., Advances in Experimental Medicine and
Biology, vol. 99, Plenum, New York 1978).
Taking into account the impressive amount of data that have emerged
during the last few years, we have decided that we shall meet and discuss
them; we hoped also that the publication of the scientific material might
be useful for everybody interested in the physiology and pathophysiology
of breathing, anesthesia and sleep. So we met in Warsaw under the
auspices of the European Society for Clinical Respiratory Physiology and
the Polish Academy of Sciences, we discussed vividly many fascinating
papers presented by our Colleagues from Europe and America and Plenum
Press has published the proceedings. I hope that the final result
will satisfy the reader.
Witold A. Karczewski
v
CONTENTS
Opening Remarks . . 1
W.A. Karczewski
Sleep as a Physiological Phenomenon .........•.... 3
J. Nar~bski
Heavy Snorers Disease • . . . . . . . . . . 5
E. Lugaresi, F. Cirignotta, G. Coccagna,
P. Montagna, M. Zucconi
Hypoxia During Sleep. . . . . ......... . 19
G. Bonsignore, 0. Marrone, V. Bellia, F. Cibella
The Upper Airway ~luscles: Their Role in Sleep-Related
Respiratory Dysrhythmias ........... . 29
N.S. Cherniack, D.W. Hudgel
Effectiveness and Side-Effects of Nasal Continuous
Positive Pressure Therapy in 66 Patients with
Sleep Apnea . . . . . . . . . . . . . . . . . 39
H. Becker, U. Koehler, J.H. Peter, M. Steinberg,
P.von Wichert
The Influence of Obesity on Disordered Breathing in
Patients with Obstructive Sleep Apnea Syndrome
/OSAS/ .................... . 43
A. Brzecka
Chronic Obstructive Pulmonary Disorders (COPD) and
Sleep . . . ........... . 47
A. Gianotti, P. Moscatelli, N. Franconieri
Polysomnographic Findings in Patients with Chronic
Obstructive Pulmonary Disease (COPD) ..... 49
E. Gozlikirmizi, N. Yildirim, H. Kaynak,
S. Madazioglu, H. Denktas, F. Yenel
High and Fluctuating Muscle Nerve Sympathetic Activity
in the Sleep Apnea Syndrome: A Pathogenetic
Mechanism in the Development of Hypertension ? 55
J. Hedner, J. Sellgren, H. Ejnell, G. Wallin
Cephalometry for Evaluation of Geometry of the Upper
Airway ................... . 61
A. Kukwa, B. de Berry-Borowiecki, R.M.I. Blanks,
I. Fleszar, A. Komorowska, M. Ryba
vii
The Clinical Relevance of Very Severe Pure Diaphragm
Weakness ............... . 65
C. Laroche, N. Carroll, A. Mier, C. Brophy, M. Green
Cardiac Involvement in Obstructive Sleep Apnea Syndrome
(OSAS) - Case Report ...... . 67
M. MigdaJ, K. Kubicka, W. Kawalec, L. OrYowski,
M. Zubrzycka, P.S. Gutkowski
RespiratoryPatterning and Arterial Oxygenation During
Sleep in Laryngectomised Patients . . . . . . 73
W. Oldfield, L. Sawicka, M.S. Meah, W.N. Gardner
Vagal Reactivity During Sleep: Study of the
Oculocardiac and the Hering-Breuer Reflex in
Preterms ................. . 77
J. Ramet, J.P. Praud, A.M. D'Allest, A. Carofils,
M. Dehan, Cl. Gaultier
Resumption of Ventilation at the End of Obstructive
Sleep Apneas is not Determined by Diaphramatic
Fatigue ..... . 83
S. Sanci, F. Cibella, 0. Marrone, G. Cuttitta,
R. Modica, S. Romano, V. Belli.a
The Effect of Chronic Pulmonary Denervation on the
Pattern of Breathing During Sleep in Man . . 89
S.A. Shea, R.L. Horner, E. McKenzie, N.R. Banner,
M.H. Yacoub, A. Guz
Conchoplasty in the Treatment of the Obstructive Sleep
Apnea Syndrome . . . . . . . . . . . . . . . . . 95
H. Skarzynski, W. Jeglinski, A. Kt~wa, G. Opolski,
M. Ryba, z. Szlenk, P. Radzimowski, M. Lisicka
The Effects of Adeno- and Tonsillectomy in Children with
Sleep Apnea Syndrome ........... . 97
H. Skarzynski, A. Kukwa, G. Opolski, R. Krauze,
W. Jeglinski, K. SYomka, A. Kalotka-Bratek
Surgery Therapy for Obstructive Sleep Apnea - Present
and Future .................. . 99
B. de Berry-Borowiecki
Anesthesia and Central Nervous System 105
B.K. Siesjo
Respiration and Anesthesia . . . . . . . . . . . . . . . . . . 107
B. Kaminski
Control of Breathing by Neuropeptides ..... 111
M.P. Morin-Surun, J. Champagnat, A. Foutz,
M. Denavit-Saubie
Neurotransmission and Neuromodulation Involved in the
Control of Respiration . . . . . . . . . . . . . 119
P. Grieb
The Control of Breathing Movements in the Fetus 133
G.S. Dawes
viii
Pathophysiology of Sudden Infant Death Syndrome ....... . 141
Cl. Gaultier
Depression of Excitatory Amino Acid Neurotransmitters
in Brain During Carbon Dioxide Narcosis, Anesthesia
and Hypoxia: Glutamic Acid and Aspartic Acid . 149
R.E. Dutton, P.J. Feustel, E.H. Dutton, A. Szema,
V.E. Shih, P.M. Renzi, G.D. Renzi
Respiratory Actions of Cholecystokinin and its
Interaction with Opioids at the Brainstem Level ..... 155
M.A. Hurle, M.M. Dierssen, M.P. Morin-Surun,
J. Fl6rez
Influence of the Neurohormones: Hwnan Corticotropin
Releasing Factor (hCRF), Thyrotropin Releasing
Hormone (TRH), Adrenocorticotrophic Hormone (ACTH)
on Ventilation in Humans . . . . . . . . . . . . . 159
M. Nink, I. Huber, U. Krause, H. Lehnert
Tube Breathing under General Anesthesia ....... . 163
V. Smejkal, F. Palecek, R. Havelka, D. Miloschewsky
Effects of Enflurane on the Ventilatory Response to
Increased Carbon Dioxide and Metabolic Rate in
Dogs ................ · · · 167
D.S. Ward, R. Ginsburg, I.H. Abdul-Rasool, K. Aqleh
Effects of Changes in Inspiration Volume and Flow Rate
on Respiratory Activity ........... . 173
M.D. Altose, A.F. Connors Jr., A.F. DiMarco
Excitatory Effects of Electrical and Chemical
Stimulation of the Botzinger Complex on
Expiratory Activity in the Cat .. 177
F. Bongianni, G. Fontana, T. Pantaleo
Trigeminal Nerve, Breathing and Sleep Apnea ...... . 183
H. Gromysz, A. Kukwa, U. Jernajczyk, W.A. Karczewski
Lateralized Response of the Hypoglossal, Facial and
Phrenic Nerves to Lung Inflation . . . . . . . 187
W.A. Janczewski
Laryngeal Contribution to Respiratory Pattern in
Nlesthetized Rabbits ........ . 193
B. Kamosinska, M. Szereda-Przestaszewska
Propriospinal Inspiratory Neurons in the Upper Cervical
Spinal Cord of the Rabbit: Location and Efferent
Spinal Projections . . . . . . . . . . . . . . . . 197
L. Kubin, J.R. Romaniuk
Spectral Analysis of Breathing Pattern in Man During
Exercise . . . . . . . . . . . . . . . . . . 203
J. Siegelova, S. Feitova
Disturbed Patency of the Upper Airway and Its
Consequences . . . . . . . . . . . . . . . 207
H. Skar~ynski, W. Jeglinski, A. Kukwa, G. Opolski,
K. SJomka, ~. Ryba, R. Krauze
ix
The Vagus Nerve and the Control ot Breatning During
Postnatal Development ............ . 209
D. Marlot
Neural Mechanisms That Lead to Apnea . . . . . 217
A.I. Pack, L.R. Kline, J.C. Hendricks, M.F. Cola
Comparison of the Importance of Mechanisms Taking Part
in Self-Regulation of Breathing ........ . 227
V.D. Glebovski
Closing Remarks .. 239
W.A. Karczewski
PARTICIPANTS 241
INDEX 243
X
OPENING REMARKS
Witold A. Karczewski
Department of Neurophysiology, Polish Academy of Sciences
Medical Research Centre, Warsaw, Poland
In an ancient text written in China about 3000 years ago and called
"The Yellow Emperor's Canon of Internal Medicine" we can encounter the
following dialogue:
"The Yellow Emperor said: 'If one is afflicted with abnormal respiration,
one cannot sleep and one's breathing has noise; ( ... )What organs in
the body cause this? I desire to hear about the etiology.'
Ch'i Po answered: 'Those who cannot sleep and breathe with noise have
disorders in the Yang Ming. Usually the three Yang of the foot travel
downward. In these cases they travel upward, hence the noise ... '
The Yellow Emperor said: 'Excellent'."
(cf. Kao, F.F., 1975, Respiratory Research in the People's Republic of
China, Geographic Health Studies, John E. Fogarty Int. Center, U.S. DREW
Publication, Washington D.C., pp.31-32).
One can very easily imagine a similar dialogue being held today;
obviously, we wouldn't use the notion of Yang Ming to explain the
mechanisms of breathing disturbances during sleep, and since we are
usually very critical of other people's work nobody would say "excellent"
listening to his or her colleague's interpretation. Otherwise, however, I
am not sure that we would be prepared to give more precise answers to the
Yellow Emperor's question.
!'lore or less the same applies to the effects of various anaesthetics,
sedatives and narcotics on the respiratory pattern generator; respiratory
neurophysiologists would be grateful if somebody would be kind enough to
explain for example why the depressant effect of one group of drugs (e.g.
volatile anaesthetics) consists in a rapid and shallow breathing, whereas
another drug - or group of drugs - will slow breathing with less effect
on tidal volume (cf. Pavlin, E.G., and T.F. Hornbein, 1985, Anesthesia
and the control of ventilation, in: "Handbook of Physiology - The
Respiratory System II", Chapter 25, Amer. Physiol. Soc., Bethesda, MD.).
The problem is quite serious since anaesthesia is an inherent part of our
present paradigm; moreover, we are sometimes trying to use anaesthetics
or narcotics as experimental tools; perhaps we shouldn't.
There ar·e many more questions and I hope that this Symposium will
give us answers to at least some of them. I am sure also that the papers
