Increased ventilatory variability and complexity in patients with hyperventilation disorder
Increased ventilatory variability and complexity in patients with hyperventilation disorder
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DOI：
10.1152/japplphysiol.00859.2015
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发表时间：
2016-05-15
影响因子：
3.3
通讯作者：
Delclaux, Christophe
中科院分区：
文献类型：
--
作者：
Bokov, Plamen;Fiamma, Marie-Noelle;Delclaux, Christophe
据推测，过度通气障碍的特征可能是异常的呼吸控制，导致静息通气的变异性增强。潮气量（VT）的变异性通常表现为非正态分布，可以通过表征增强呼吸的负斜率来描述，该负斜率由双对数尺度上VT和VT的概率密度分布之间的关系形成。本研究的目的是描述静息通气的变异性[VT和斜率的变异系数（CV）]、呼吸控制的稳定性（回路，控制器和植物增益表征通气-化学反应性相互作用）和混沌样动力学（嵌入维数，表征复杂性的Kappa值），定义的功能障碍性呼吸模式，其特征为心肺运动试验期间的空气饥饿和PaCO 2持续降低。与14名人体测量学相似的健康受试者相比，23名过度通气患者的特征是静息潮气通气的变异性增加（VT中位数的CV [四分位数]：26% [19-35] vs. 36% [28-48]，P = 0.020;斜率：-6.63 [-7.65; -5.36] vs. -3.88 [-5.91;-2.66]，P = 0.004），与化学驱力增加无关（环路增益：0.051 [0.039-0.221] vs. 0.044 [0.012-0.087]，P = 0.149），但这与解释复杂性增加有关（Kappa值，P < 0.05）。患者的植物生长减少，并与复杂性相关（Kappa 5度5：Rho =-0.48，P = 0.006）。总之，明确定义的过度通气障碍患者的特征是由于呼吸复杂性增加，通气-化疗反应性相互作用稳定，静息通气的变异性增加。
It has been hypothesized that hyperventilation disorders could be characterized by an abnormal ventilatory control leading to enhanced variability of resting ventilation. The variability of tidal volume (VT) often depicts a nonnormal distribution that can be described by the negative slope characterizing augmented breaths formed by the relationship between the probability density distribution of VT and VT on a log-log scale. The objectives of this study were to describe the variability of resting ventilation [coefficient of variation (CV) of VT and slope], the stability in respiratory control (loop, controller and plant gains characterizing ventilatory-chemoresponsiveness interactions) and the chaotic-like dynamics (embedding dimension, Kappa values characterizing complexity) of resting ventilation in patients with a well-defined dysfunctional breathing pattern characterized by air hunger and constantly decreased PaCO2 during a cardiopulmonary exercise test. Compared with 14 healthy subjects with similar anthropometrics, 23 patients with hyperventilation were characterized by increased variability of resting tidal ventilation (CV of VT median [interquartile]: 26% [19-35] vs. 36% [28-48], P = 0.020; slope: -6.63 [-7.65; -5.36] vs. -3.88 [-5.91; -2.66], P = 0.004) that was not related to increased chemical drive (loop gain: 0.051 [0.039-0.221] vs. 0.044 [0.012-0.087], P = 0.149) but that was related to an increased ventilatory complexity (Kappa values, P < 0.05). Plant gain was decreased in patients and correlated with complexity (with Kappa 5 - degree 5: Rho = -0.48, P = 0.006). In conclusion, well-defined patients suffering from hyperventilation disorder are characterized by increased variability of their resting ventilation due to increased ventilatory complexity with stable ventilatory-chemoresponsiveness interactions.