Regulation of Breathing during Sleep? Chronic ...

Chronic Mountain Polycythemia: A Disorder of the Regulation of Breathing during Sleep? Meir Kryger, John Weil and Robert Grover Chest 1978;73;303-304 DOI 10.1378/chest.73.2_Supplement.303 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/73/2_Supplement/303.citation

Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1978by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692

Downloaded from chestjournal.chestpubs.org by guest on July 9, 2011 1978, by the American College of Chest Physicians

of

apnea

were

were

most

sleep

and

there

REM

was

arousal

cycle

3 of

sleep

onset

led

terminated

by

on

the

the

setting

5

lasted

appeared

but

stage light

2

periodic

hypopnea.

On Apnea

of the

experienced

the

desaturation

duration

and

less

than

episodes

apnea

were

and

prolonged

desaturation, marked

than

5 minutes

2)

seen

they

changes

REM

in sleep. in 3

saturation

Although

.

during

did

of

occurred

in oxygen

(Fig

was

associated

during

fall

mean

periods

desaturation

maximal 22%

the episodes

prolonged

exclusively

was

seconds; these

greater

of prolonged mean

breathing

for

periodic

REM-associated

not

appear

to account

noted. DiscussioN

ing

studies

indicate

oxygen

desaturation

both

stance,

naps

and

79

episodes

of

daytime patients

naps with

disordered

at sleep

it is usually

of short

sleep-disordered patients

with

because

of

may

the

than

of

This

hand,

we

sleep.

These

than

5 minutes,

disordered

routine function resting portion

The further

to

cannot

shown

in

other and

importance sleep

to be

patients

with

as yet unrecognized neuropsychologic con-

of

physiologic

be

underestimated

changes

oc-

and

de-

study.

the

oxygen-

they

are

also

experience

breathing seen

true

noted

of

dis-

in several

episodes,

but

prolonged

were

appear

REM

frequently

caused

with severe

during

to result

were

none

of

the

laboratory tests. arterial of

our

patients

occurrence from medical data, However, oxygen the

oxygen

was of

it

longer

directly by

from

some

other

possible

to

gas as

tension

a

analysis, group,

fell

hemoglobin

on

Mountain

Disorder

of the

Polycythemia: Regulation

during

A

of

Sleep?

de-

or pulmonary patients or near

dissociation

CHEST, 73: 2, FEBRUARY, 1978 SUPPLEMENT

whose the

Meir M.D.

C

Kryger,

M.D.;

hronic

mountain

excessive people clear.

John

has

responses

at

and

and

Robert

Grover,

(CMP) high

polycythemia been

is

altitude.

and

others

do

cause

hypoventilation

that

We

the

tory response to hypoxia normal subjects residing

blunted

steep curve

depressed

compared

hypoxic

drive

altitude

residents

*From Reprint Winnipeg,

the

is un-

ventilatory

studied

leads

to

ventila-

in 17 patients with CMP and 10 at 3100 m. There was no differ-

to low

to breathe

University

to some

not

that

polycythemia.

due

Why

suggested

to hypoxia

hypoxemia

M.D.;

polycythemia

hypoxemia

develop It

Weil,

ence in hypoxic response between the CMP patients the normal subjects although in both, responses

predict

disordered breathing or history, physical examination,

blood

Chronic

the

patients

patients

which not

is not

in

the

1 Flick MR, Block AJ: Continuous in vivo monitoring of arterial oxygenation in chronic obstructive lung disease. Ann Intern Med 86:725-730, 1977 2 Koo KW, Sax DS, Snider CL: Arterial blood gases and pH during sleep in chronic obstructive pulmonary disease. Am J Med 58:663-670, 1975 3 Pierce AK, Jarrett CE, Werkle C Jr. et al: Respiratory function during sleep in patients with chronic obstructive lung disease. J Clin Invest 45:631-636, 1966 4 Trask CH, Cree EM : Oximeter studies on patients with chronic obstructive emphysema, awake and during sleep. N Engi J Med 266:639-642, 1962 5 Cuilleminault C, Tilkian A, Dement WC: The sleep apnea syndromes. Ann Rev Med 27:465-484, 1976 6 Webb P: Periodic breathing during sleep. J Appl Physiol 37:899-903, 1974 7 Wynne JW, Block AJ, Hunt LA, et al: Sleep apnea during daytime naps in patients with chronic obstructive lung disease ( COLD). Am Rev Respir Dis 115( Suppl) :181, 1977 ( abstract) 8 Flick MR, Block AJ: Cardiac arrthythmias in chronic obstructive lung disease ( COLD). Effect of low flow oxygen administration. Am Rev Respir Dis 113( Suppl): 126, 1976

Breathing

to develop

mechanism. In

may lead hematologic,

during

been

arrhythmias

breathing

on to

disordered

breathing,

subjects,

prone

subjects

Although

.

normal

Whether

desaturation

did

seconds) in

known.

is especially

desaturation

sleep;

position

normal

sleep

is most

REM

disordered

curve.

is not

other

cause

reliably saturation

cardiac

desaturation. already

disordered

during

60

with

in 10 disor-

but

be especially

precarious

breathing

COPD.

(