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Infant periodic breathing and apneic threshold
Stanley M Yamashiro1, Narayan P Iyer2
1Biomedical Engineering Department, University of Southern California, Los Angeles, California, USA.
Physiological Reports
|January 19, 2024
Summary
The apneic threshold significantly influences periodic breathing in preterm infants, especially when combined with spontaneous sighs. This nonlinear factor helps explain sustained periodic breathing patterns observed in infants.
Area of Science:
- Physiology
- Neonatal Medicine
- Mathematical Modeling
Background:
- Previous models using linear control theory could not fully explain sustained periodic breathing in preterm infants.
- The nonlinear nature of the apneic threshold and its role in CO2 regulation was not adequately addressed.
- Brain vascular volume changes with CO2, affecting chemoreceptor time delay, is another unexplored nonlinear factor.
Purpose of the Study:
- To develop a mathematical model predicting the role of apneic threshold in infant periodic breathing.
- To investigate the impact of nonlinear factors like apneic threshold and brain vascular volume on periodic breathing.
- To explore the influence of chemoreceptor gains, cardiac output, lung volume, and circulatory time delay.
Main Methods:
- Development of a nonlinear mathematical model incorporating apneic threshold, chemoreceptor gains, cardiac output, lung volume, and circulatory time delay.
- Simulation of ventilatory responses to spontaneous sighs within the model.
- Estimation of peripheral chemoreceptor gain using endogenous CO2 levels.
Main Results:
- The apneic threshold plays a critical role in ventilatory responses to spontaneous sighs, leading to apneic pauses and subsequent periodic breathing.
- Exceeding the apneic threshold causes asymmetry and increased frequency in periodic breathing cycles.
- Model predictions for periodic breathing cycle duration, as a function of age, were validated using peripheral chemoreceptor gain.
- Increased brain vascular volume with CO2 contributes to periodic breathing in very young preterm infants.
Conclusions:
- Spontaneous sighs, by repeatedly stimulating the respiratory system, can promote continuous periodic breathing in infants.
- The apneic threshold is a key nonlinear factor contributing to the instability and patterns of periodic breathing in preterm infants.
- The model provides insights into the complex interplay of factors causing periodic breathing, aiding in understanding and potentially managing this condition.
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