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Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
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Adaptive cardiorespiratory changes to chronic continuous and intermittent hypoxia.

Nanduri R Prabhakar1, Ying-Jie Peng1, Jayasri Nanduri1

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Summary

Chronic hypoxia (CH) from high altitude and chronic intermittent hypoxia (CIH) in obstructive sleep apnea (OSA) cause distinct cardiorespiratory changes. CH adaptations differ from CIH pathologies, involving carotid body chemo reflex and hypoxia-inducible factors.

Keywords:
Carotid body chemo reflexEpigeneticsHypertensionHypoxia-inducible factorsObstructive sleep apnea

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Area of Science:

  • Cardiorespiratory physiology
  • Altitude medicine
  • Sleep medicine

Background:

  • Chronic hypoxia (CH) at high altitude and chronic intermittent hypoxia (CIH) in obstructive sleep apnea (OSA) induce significant cardiorespiratory adaptations and pathologies.
  • The carotid body (CB) chemo reflex plays a crucial role in mediating responses to hypoxia.
  • Hypoxia-inducible factors (HIFs) are key molecular regulators of hypoxic responses.

Purpose of the Study:

  • To review cardiorespiratory adaptations to chronic hypoxia (CH) at high altitude.
  • To examine cardiorespiratory pathologies elicited by chronic intermittent hypoxia (CIH) in obstructive sleep apnea (OSA).
  • To compare the mechanisms underlying responses to sustained versus intermittent hypoxia.

Main Methods:

  • Review of literature on cardiorespiratory physiology under hypoxic conditions.
  • Analysis of molecular and cellular mechanisms involved in hypoxic responses.
  • Comparison of adaptations to high-altitude CH versus CIH in OSA.

Main Results:

  • Short-term CH enhances breathing and blood pressure via CB chemo reflex, involving HIFs.
  • Long-term CH in high-altitude natives leads to blunted hypoxic ventilatory response and reduced blood pressure due to CB desensitization.
  • CIH in OSA patients and rodents causes heightened CB chemo reflex, increased hypoxic ventilatory response, and hypertension, mediated by reactive oxygen species (ROS).

Conclusions:

  • Cardiorespiratory responses to CH and CIH differ significantly, with distinct underlying mechanisms.
  • CH adaptations involve HIF transcriptional activation, while CIH pathologies are linked to ROS generation and disrupted HIF signaling.
  • Understanding these differences is crucial for managing conditions related to hypoxia.