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Basic Sciences-The Human Body - The Respiratory

Basic Sciences-The Human Body - The Respiratory

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Published by Mohammad Bahadori

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Published by: Mohammad Bahadori on Dec 02, 2010
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Variations in breathing result from changes in metabolic
demands in the tissues of the body. For example, during
exercise, increased levels of oxygen are needed to fuel
muscle function, and thus breathing generally becomes
deeper and the number of breaths taken per minute
increases. At the opposite end of the spectrum, during
sleep, the body’s metabolic rate slows, and thus breathing
typically becomes lighter. However, the association
between sleep and breathing is more complicated than
this because brain activity changes as a person progresses
through the different stages of sleep. This in turn leads to
fuctuations in breathing patterns.


Mechanoreceptors, arterial chemoreceptors, and thermal receptors all work in
concert during exercise to enhance ventilation. Shutterstock.com


One of the remarkable features of the respiratory control
system is that ventilation increases suffciently to keep the
partial pressure of carbon dioxide in arterial blood nearly
unchanged despite the large increases in metabolic rate
that can occur with exercise, thus preserving acid–base
homeostasis. A number of signals arise during exercise
that can augment ventilation. Sources of these signals
include mechanoreceptors in the exercising limbs; the
arterial chemoreceptors, which can sense breath-by-
breath oscillations in the partial pressure of carbon
dioxide; and thermal receptors, because body tempera-
ture rises as metabolism increases.

7 Control and Mechanics of Breathing 7

7 The Respiratory System 7


The brain also seems to anticipate changes in the met-
abolic rate caused by exercise, because parallel increases
occur in the output from the motor cortex to the exercis-
ing limbs and to respiratory neurons. Changes in the
concentration of potassium and lactic acid in the exercis-
ing muscles acting on unmyelinated nerve fbres may be
another mechanism for stimulation of breathing during
exercise. It remains unclear, however, how these various
mechanisms are adjusted to maintain acid–base balance.


During sleep, body metabolism is reduced, but there is an
even greater decline in ventilation so that the partial pres-
sure of carbon dioxide in arterial blood rises slightly and
arterial partial pressure of oxygen falls. The effects on ven-
tilatory pattern vary with sleep stage. In slow-wave sleep,
breathing is diminished but remains regular, whereas in
rapid eye movement sleep, breathing can become quite
erratic. Ventilatory responses to inhaled carbon dioxide
and to hypoxia are less in all sleep stages than during wake-
fulness. Suffciently large decreases in the partial pressure
of oxygen or increases in the partial pressure of carbon
dioxide will cause arousal and terminate sleep.
During sleep, ventilation may swing between periods
when the amplitude and frequency of breathing are high
and periods in which there is little attempt to breathe, or
even apnea (cessation of breathing). This rhythmic waxing
and waning of breathing, with intermittent periods of
apnea, is called Cheyne-Stokes breathing, after the physi-
cians who frst described it. The mechanism that produces
the Cheyne-Stokes ventilation pattern is still argued, but
it may entail unstable feedback regulation of breathing.
Similar swings in ventilation sometimes occur in persons
with heart failure or with central nervous system disease.


In addition, ventilation during sleep may intermit-
tently fall to low levels or cease entirely because of partial
or complete blockage of the upper airways. In some indi-
viduals, this intermittent obstruction occurs repeatedly
during the night, leading to severe drops in the levels of
blood oxygenation. The condition, termed sleep apnea
syndrome, occurs most commonly in the elderly, in the
newborn, in males, and in the obese. Because arousal
is often associated with the termination of episodes
of obstruction, sleep is of poor quality, and complaints of
excessive daytime drowsiness are common. Snoring and
disturbed behaviour during sleep may also occur.
In some persons with sleep apnea syndrome, portions
of the larynx and pharynx may be narrowed by fat deposits
or by enlarged tonsils and adenoids, which increase the
likelihood of obstruction. Others, however, have normal
upper airway anatomy, and obstruction may occur because
of discoordinated activity of upper airway and chest wall
muscles. Many of the upper airway muscles, like the
tongue and laryngeal adductors, undergo phasic changes
in their electrical activity synchronous with respiration,
and the reduced activity of these muscles during sleep may
lead to upper airway closure.

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