Effects of diving and oxygen on autonomic nervous system and cerebral blood flow

Recreational scuba diving is a popular leisure activity with the number of divers reaching several millions worldwide. Scuba diving represents a huge challenge for integrative physiology. In mammalian evolution, physiological reflexes developed to deal with lack of oxygen, rather than with an excess, which makes adaptations to scuba diving more difficult to describe and understand than those associated with breath-hold diving. The underwater environment significantly limits the use of equipment to register the organism's functions, so, in most instances, scientific theories are built on experiments that model real diving to some extent, like hyperbaric exposures, dive reflexes or water immersion. The aim of this review is to summarise the current knowledge related to the influence exerted by physiological conditions specific to diving on the autonomic nervous system and cerebral blood flow. The main factors regulating cerebral blood flow during scuba diving are discussed as follows: 1) increased oxygen partial pressure; 2) immersion-related trigemino-cardiac reflexes and 3) exposure to cold, exercise and stress. Also discussed are the potential mechanisms associated with immersion pulmonary oedema.