Does buspirone ameliorate the susceptibility to central sleep apnea?
Does buspirone ameliorate the susceptibility to central sleep apnea?
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丁螺环酮是否可以改善中枢性睡眠呼吸暂停的易感性？
DOI：
10.1152/japplphysiol.01077.2020
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Sankari,Abdulghani
中科院分区：
文献类型：
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作者：
Maresh,Scott;Prowting,Joel;Vaughan,Sarah;Yarandi,Hossein;Badr,MSafwan;Sankari,Abdulghani
我们同意 Borrelli 等人 (1) 关于丁螺环酮在总体上降低控制器增益升高方面的重要作用，我们的研究发现就是这种情况。然而，脊髓损伤（SCI）和心力衰竭之间存在不同的病理生理学机制，在评估丁螺环酮给药的临床反应时需要考虑这些机制。我们实验室最近的一项研究 (4) 表明，慢性 SCI 患者由于对颈动脉体的依赖性增强，其外周化疗敏感性显着增加。与身体健全的对照受试者相比，SCI 患者对单次呼吸 CO2 的反应显示每分钟通气量显着增加，并且在高氧后潮气量显着减少 (4)。此外，据报道，与健全对照相比，颈椎 SCI 参与者在急性间歇性缺氧后表现出每分钟通气量增加，表明对缺氧的化疗敏感性更高 (5)。然而，这些显着的化学敏感性变化在急性 SCI 中可能表现不同。因此，我们在丁螺环酮和曲唑酮研究中仅纳入了慢性 SCI。我们的结果与 Borrelli 及其同事的结果 (3) 的一些差异可能可以通过研究人群的差异（SCI 与心力衰竭）来解释。其他方法学差异包括较高的中枢呼吸暂停指数（CAI），这可能导致丁螺环酮反应的显着差异。此外，Borrelli 及其同事 (3) 将丁螺环酮剂量调整至 45 毫克，而我们的最大剂量为 30 毫克。尽管丁螺环酮这种潜在应用的最佳剂量可能尚不清楚，但重要的是要记住这种药物可能存在剂量反应。
We agree with Borrelli et al.(1) regarding the important role of buspirone in reducing the elevated controller gain in general, which was found to be the case in our study. However, there are different pathophysiological mechanisms between spinal cord injury (SCI) and heart failure that need to be taken into consideration in assessing the clinical response to the administration of buspirone. A recent study from our laboratory (4) demonstrated that individuals with chronic SCI had a significant increase in peripheral chemosensitivity due to a heightened reliance on the carotid body. Patients with SCI exhibit a significant increase in minute ventilation in response to a single breath of CO2 and display a more considerable decrease in tidal volume following hyperoxia than able-bodied control subjects (4). In addition, it has been reported that participants with cervical SCI demonstrate increased minute ventilation following acute intermittent hypoxia compared with able-bodied controls, indicating heightened chemosensitivity to hypoxia (5). However, these noted changes in chemosensitivity may manifest differently in acute SCI. Hence, we included only chronic SCI in the buspirone and trazodone study.Some differences in our results and those of Borrelli and colleagues (3) can be potentially explained by differences in the study populations (SCI vs. heart failure). Other methodological differences include higher central apnea index (CAI), which may contribute to the noted difference in the response to buspirone. In addition, Borrelli and colleagues (3) titrated up to a buspirone dosage of 45 mg compared with our maximum dosage of 30mg. Although the optimal buspirone dosage for this potential application may be unclear, it is important to keep in mind that a dose response may exist for this medication.