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Canadian Association of Neuroscience Review: Respiratory Control and Behavior in Humans: Lessons from Imaging and Experiments of Nature

Published online by Cambridge University Press:  02 December 2014

Immanuela Ravé Moss
Immanuela Ravé Moss*
Affiliation:
Departments of Pediatrics and Physiology, McGill University and McGill University Health Centre Research Institute, Montreal Children's Hospital and Montreal Children's Hospital Research Institute, Montreal, Quebec, Canada
*
Departments of Pediatrics and Physiology, McGill University. The Montreal Children’s Hospital, Room A-707, 2300 Tupper Street. Montreal, QC H3H 1P3 Canada.
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Abstract:

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The purpose of this review is to demonstrate that respiration is a complex behavior comprising both brainstem autonomic control and supramedullary influences, including volition. Whereas some fundamental mechanisms had to be established using animal models, this review focuses on clinical cases and physiological studies in humans to illustrate normal and abnormal respiratory behavior. To summarize, central respiratory drive is generated in the rostroventrolateral medulla, and transmitted to both the upper airway and to the main and accessory respiratory muscles. Afferent feedback is provided from lung and muscle mechnoreceptors, peripheral carotid and aortic chemoreceptors, and multiple central chemoreceptors. Supramedullary regions, including cortex and subcortex, modulate or initiate breathing with volition, emotion and at the onset of exercise. Autonomic breathing control can be perturbed by brainstem pathology including space occupying lesions, compression, congenital central hypoventilation syndrome and sudden infant death syndrome. Sleep-wake states are important in regulating breathing. Thus, respiratory control abnormalities are most often evident during sleep, or during transition from sleep to wakefulness. Previously undiagnosed structural brainstem pathology may be revealed by abnormal breathing during sleep. Ondine's curse and 'the locked-in syndrome' serve to distinguish brainstem from supramedullary regulatory mechanisms in humans: The former comprises loss of autonomic respiratory control and requires volitional breathing for survival, and the latter entails loss of corticospinal or corticobulbar tracts required for volitional breathing, but preserves autonomic respiratory control.

Résumé:

RÉSUMÉ:

Le but de cette revue est de démontrer que la respiration est un acte complexe impliquant un contrôle neuro-végétatif provenant du tronc cérébral et des influences supramédullaires, entre autres la volonté. Alors que les mécanismes fondamentaux ont dû être établis grâce à des modèles animaux, cette revue est axée sur des cas cliniques et des études physiologiques chez l’humain afin d’illustrer le comportement respiratoire normal et anormal. En résumé, la stimulation respiratoire centrale origine de la moelle rostro-ventro-latérale et elle est transmise aux voies aériennes supérieures et aux muscles respiratoires principaux et accessoires. La rétroaction afférente provient de mécanorécepteurs pulmonaires et musculaires, de chémorécepteurs périphériques à la carotide et à l’aorte et de multiples chémorécepteurs centraux. Des régions supramédullaires corticales et sous-corticales jouent un rôle dans la modulation ou le déclenchement de la respiration par la volonté, l’émotion et en début d’exercice. Le contrôle neuro-végétatif de la respiration peut être perturbé par une pathologie du tronc cérébral, soit par une lésion expansive, une compression, le syndrome congénital d’hypoventilation alvéolaire central et le syndrome de la mort subite du nourrisson. Les états de sommeil et d’éveil sont importants dans la régelation de la respiration. Des anomalies du contrôle respiratoire sont plus souvent évidentes pendant le sommeil ou pendant la période de transition du sommeil à l’éveil. Une respiration anormale pendant le sommeil peut révéler une pathologie structurale du tronc cérébral encore non détectée. Le syndrome d’Ondine et le syndrome de déefférentation motrice (locked-in syndrome) distinguent les mécanismes régulateurs du tronc cérébral des mécanismes supramédullaires chez l’humain: les premiers comportent une perte du contrôle respiratoire neuro-végétatif et la survie dépend alors de la respiration volontaire et les derniers impliquent la perte des voies corticospinales ou corticobulbaires nécessaires à la respiration volontaire, mais préservent le contrôle respiratoire neurovégétatif.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 3 , August 2005 , pp. 287 - 297
Copyright
Copyright © The Canadian Journal of Neurological 2005

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