Maximal Breath-holds Research Articles

Acute ergogenic effects of repetitive maximal breath-holding maneuvers on hematological and physiological responses: a graded exercise test investigation.

Repetitive maximal breath-holds (BHs or apneas) have been noted to induce advantageous hematological and blood buffering changes. Building on this, the hypothesis was formulated that the execution of repeated maximal BH efforts might lead to subsequent enhancements in performance during a time-to-exhaustion test. This study investigated the acute effects of five static maximal breath-holding maneuvers conducted with face immersion in cold water (10°C) on subsequent graded exercise test (GET) performance. Seventeen well-trained participants completed a GET on a motorized treadmill under two randomized cross-over conditions: baseline measurement (CON) and after five repeated maximal breath-holding efforts (EXP). The GET protocol consists of incremental increases in speed until exhaustion. After the fifth breath-hold, participants in the EXP condition exhibited significant (P < 0.05) increases in hematocrit, hemoglobin concentration, red blood cell count, and muscle deoxygenation, accompanied by a reduction in blood lactate concentration (4.09 ± 2.21%, 3.9 ± 1.76%, 3.96 ± 2.1%, 81.48 ± 23.83%, and 15.22 ± 17.64%, respectively), compared to CON. During GET, the EXP condition showed a significantly (P < 0.05) delayed onset time of the second ventilatory threshold (3.14 ± 5.85%) and (P < 0.05) increased time to exhaustion (0.75 ± 1.02%). This evidence suggests that repeated maximal static breath-holding maneuvers enhance the oxygen delivery system by increasing the circulation of reserve red blood cells, heightened muscle oxygen deoxygenation, enhanced aerobic metabolism utilization, and postponing the transition from aerobic to anaerobic metabolism, implying a potential ergogenic effect. While pre-exercise breath-holding shows promise for improving time-to-exhaustion and optimizing subsequent distance running performance, further in-depth investigation is essential to fully elucidate the underlying mechanistic factors.

Maximal Breath Hold Associated with Inappropriate Change in Respiratory Rate in Hospitalized Covid-19 Patients Indicates a Blunted Ventilatory Response

Maximal Breath Hold Associated with Inappropriate Change in Respiratory Rate in Hospitalized Covid-19 Patients Indicates a Blunted Ventilatory Response

The effect of various breath-hold techniques on the cardiorespiratory response to facial immersion in humans.

What is the central question of this study? What is the effect of three repeated breath-hold techniques routinely used by freedivers, thought to manipulate arterial partial pressures of O2 and CO2 , on the cardiorespiratory and haematological response to breath-holding during facial immersion? What is the main finding and its importance? All three techniques increased breath-hold by a similar duration, probably owing to the similar marked increase in end-tidal O2 and decrease in end-tidal CO2 observed in all three trials before facial immersion. These were the only cardiorespiratory changes that were consistently manipulated before the maximal breath-hold. This would suggest that pronounced bradycardia and vasoconstriction of selective vascular beds are probably not obligatory for prolonging breath-hold duration. Repeated maximal breath-holds have been demonstrated to induce bradycardia, increase haematocrit and haemoglobin and prolong subsequent breath-hold duration by 20%. Freedivers use non-maximal breath-hold techniques (BHTs) to improve breath-hold duration. The aim of this study was to investigate the cardiorespiratory and haematological responses to various BHTs. Ten healthy men (34.5±1.9 years) attended five randomized experimental trials and performed a 40min period of quiet rest or one of three BHTs followed by a maximal breath-hold challenge during facial immersion in water at 30 or 10°C. Cardiovascular and respiratory parameters were measured continuously using finger plethysmography and breath-by-breath gas analysis, respectively, and venous blood samples were collected throughout. Facial immersion in cold water caused marked bradycardia (74.1 vs. 50.2beats/min after 40 s) but did not increase breath-hold duration compared with warm water control conditions. Facial immersion breath-hold duration was 30.8-43.3% greater than the control duration when preceded by BHTs that involved repeated breath-holds of constant duration (P=0.021), increasing duration (P<0.001) or increasing frequency (P<0.001), with no difference observed between BHTs. The increased duration of apnoea across all three BHT protocols was associated with a 6.8% increase in end-tidal O2 and a 13.1% decrease in end-tidal CO2 immediately before facial immersion. There were no differences in blood pressure, cardiac output, heart rate, haematocrit or haemoglobin between each BHT and control conditions (P>0.05). In conclusion, the duration of apnoea can be extended by manipulating blood gases through repeated prior breath-holds, but changes in cardiac output and red blood cell mass do not appear essential.

P059 Respiratory control stability in posttraumatic stress disorder

Abstract Rationale A recent meta-analysis indicated that 75.7% of individuals with posttraumatic stress disorder (PTSD) also suffer from obstructive sleep apnoea (OSA). The reason for the high prevalence of OSA in PTSD is currently unknown. This study investigated whether respiratory control stability (which is known to contribute to OSA in the general population) varies with PTSD symptoms. Methods First year University students were recruited and completed an online questionnaire battery including: Life Events Checklist (LEC), PTSD checklist for DSM-5 (PCL-5), Shortness of Breath Questionnaire (SOBQ) and Berlin Sleep Questionnaire. 1/3 of participants timed their maximum breath hold (performed at functional residual capacity) at home on 3 occasions using a stopwatch as per Messieno et al (2018). Results 313 complete survey responses were obtained. The mean age of participants was 19.9 years and 214 respondents were women. 19 participants were at high risk of OSA based (Berlin Questionnaire) and 80 had probable PTSD (LEC items 1-16 “happened to me” or “witnessed it” plus PCL-5&amp;gt;33). In the whole sample, there was a significant relationship between PTSD symptoms and Shortness of Breath (Pearson p&amp;lt;0.001, r2=0.2). There was no relationship between PTSD symptoms and at-home measured maximum breath-hold duration (n=107, p=0.44, r2=0.006). Conclusions In an unselected University student population, posttraumatic stress disorder symptoms are associated with self-reported shortness of breath during everyday activities. However, there was no evidence of a relationship between a surrogate of respiratory control stability (maximum breath-hold duration) and PTSD symptoms.

Blood pressure wave propagation—a multisensor setup for cerebral autoregulation studies

Objective. Cerebral autoregulation is critically important to maintain proper brain perfusion and supply the brain with oxygenated blood. Non-invasive measures of blood pressure (BP) are critical in assessing cerebral autoregulation. Wave propagation velocity may be a useful technique to estimate BP but the effect of the location of the sensors on the readings has not been thoroughly examined. In this paper, we were interested in studying whether the propagation velocity of a pressure wave in the direction from the heart to the brain may differ compared with propagation from the heart to the periphery, as well as across different physiological tasks and/or health conditions. Using non-invasive sensors simultaneously placed at different locations of the human body allows for the study of how the propagation velocity of the pressure wave, based on pulse transit time (PTT), varies across different directions. Approach. We present a multi-sensor BP wave propagation measurement setup intended for cerebral autoregulation studies. The presented sensor setup consists of three sensors, one placed on each of the neck, chest and finger, allowing simultaneous measurement of changes in BP propagation velocity towards the brain and to the periphery. We show how commonly tested physiological tasks affect the relative changes of PTT and correlations with BP. Main results. We observed that during maximal blow, valsalva and breath hold breathing tasks, the relative changes of PTT were higher when PTT was measured in the direction from the heart to the brain than from the heart to the peripherals. In contrast, during a deep breathing task, the relative change in PTT from the heart to the brain was lower. In addition, we present a short literature review of the PTT methods used in brain research. Significance. These preliminary data suggest that the physiological task and direction of PTT measurement may affect relative PTT changes. The presented three-sensor setup provides an easy and neuroimaging compatible method for cerebral autoregulation studies by allowing measurement of BP wave propagation velocity towards the brain versus towards the periphery.

Abstract P134: Preliminary Data: Dietary Nitrate Supplementation Does Not Extend Dry Static Apnea Or Wingate Performance

Introduction: Previous studies have examined dietary nitrate supplementation and its effects on dry static apnea, and peak power. Dietary nitrate supplementation has been found to increase maximal apnea and peak power output. The purpose of this study was to determine the effects of beetroot juice on dry static apnea and Wingate performance. Hypothesis: Dietary nitrate will improve maximal breath hold time and peak power output. Dietary nitrate will improve tolerance to CO2, thereby improving maximal breath hold time and anaerobic capacity. Methods: In a randomized, double-blind, counterbalanced study, five healthy males (20.4±0.89 years) visited the lab on 3 separate occasions each separated by one week. Visit 1 served as a Wingate and breath hold familiarization visit. Prior to visits 2 and 3 participants were instructed to drink a beverage either a placebo (negligible nitrate content, PL) or dietary nitrate rich beverage (12.4 mmol nitrate, NIT) during the 4 days leading up to their next visit. Visits 2 and 3 consisted of two submaximal breath holds (80% of maximal determined during visit 1), with 2 minutes of rest between and three minutes of rest preceding the final breath hold for maximal duration. Finally, participants completed a standardized 10-minute warmup on the cycle ergometer before completing a 30-second maximal effort Wingate test. Results: A linear mixed effects model was used to determine whether treatment (NIT vs. PL) was associated with differences in VCO2 or PetCO2. Time (0, 10, 20, 30 min post-breath hold) and Treatment both served as repeated measures. Models were developed using multiple repeated measures covariance matrix structures, and the model with the lowest AIC was chosen as the final model. The interaction between time and treatment was included in the original models, and was removed if it was not statistically significant. Time was a statistically significant factor for VCO2 and PetCO2 (p &lt; 0.001). Treatment, and the Time x Treatment interaction was not significant for either variable. No differences between NIT and PL were observed during the Wingate test for either time to peak power (5.02±2.45 and 6.2±2.43 sec, respectively) or maximal power (9.73±1.01 and 9.72±1.03 watts/kg, respectively) and fatigue index (49.42±14.98 and 47.30±6.99 watts/sec, respectively). Conclusion: Preliminary data indicates that in a general population four days of dietary nitrate supplementation may not improve breath hold time, tolerance to carbon dioxide in the lungs, or Wingate performance.

Breath holding as an example of extreme hypoventilation: experimental testing of a new model describing alveolar gas pathways.

What is the central question of this study? We modelled the alveolar pathway during breath holding on the hypothesis that it follows a hypoventilation loop on the O2 -CO2 diagram. What is the main finding and its importance? Validation of the model was possible within the range of alveolar gas compositions compatible with consciousness. Within this range, the experimental data were compatible with the proposed model. The model and its characteristics might allow predictions of alveolar gas composition whenever the alveolar ventilation goes to zero; for example, static and dynamic breath holding at the surface or during ventilation/intubation failure in anaesthesia. According to the hypothesis that alveolar partial pressures of O2 and CO2 during breath holding (BH) should vary following a hypoventilation loop, we modelled the alveolar gas pathways during BH on the O2 -CO2 diagram and tested it experimentally during ambient air and pure oxygen breathing. In air, the model was constructed using the inspired and alveolar partial pressures of O2 ( and , respectively) and CO2 ( and , respectively) and the steady-state values of the pre-BH respiratory exchange ratio (RER). In pure oxygen, the model respected the constraint of . To test this, 12 subjects performed several BHs of increasing duration and one maximal BH at rest and during exercise (30W cycling supine), while breathing air or pure oxygen. We measured gas flows, and before and at the end of all BHs. Measured data were fitted through the model. In air, =150±1mmHg and =0.3±0.0mmHg, both at rest and at 30W. Before BH, steady-state RER was 0.83±0.16 at rest and 0.77±0.14 at 30W; =107±7mmHg at rest and 102±8mmHg at 30W; and =36±4mmHg at rest and 38±3mmHg at 30W. By model fitting, we computed the RER during the early phase of BH: 0.10 [95% confidence interval (95% CI) =0.08-0.12] at rest and 0.13 (95% CI=0.11-0.15) at 30W. In oxygen, model fitting provided : 692 (95% CI=688-696) mmHg at rest and 693 (95% CI=689-698) mmHg at 30W. The experimental data are compatible with the proposed model, within its physiological range.

Skin Cooling on Breath-Hold Duration and Predicted Emergency Air Supply Duration During Immersion.

PURPOSE: This study was intended to determine the effect of skin cooling on breath-hold duration and predicted emergency air supply duration during immersion.METHODS: While wearing a helicopter transport suit with a dive mask, 12 subjects (29 ± 10 yr, 78 ± 14 kg, 177 ± 7 cm, 2 women) were studied in 8 and 20°C water. Subjects performed a maximum breath-hold, then breathed for 90 s (through a mouthpiece connected to room air) in five skin-exposure conditions. The first trial was out of water for Control (suit zipped, hood on, mask off). Four submersion conditions included exposure of the: Partial Face (hood and mask on); Face (hood on, mask off); Head (hood and mask off); and Whole Body (suit unzipped, hood and mask off).RESULTS: Decreasing temperature and increasing skin exposure reduced breath-hold time (to as low as 10 ± 4 s), generally increased minute ventilation (up to 40 ± 15 L · min-1), and decreased predicted endurance time (PET) of a 55-L helicopter underwater emergency breathing apparatus. In 8°C water, PET decreased from 2 min 39 s (Partial Face) to 1 min 11 s (Whole Body).CONCLUSION: The most significant factor increasing breath-hold and predicted survival time was zipping up the suit. Face masks and suit hoods increased thermal comfort. Therefore, wearing the suits zipped with hoods on and, if possible, donning the dive mask prior to crashing, may increase survivability. The results have important applications for the education and preparation of helicopter occupants. Thermal protective suits and dive masks should be provided.Madu VC, Carnahan H, Brown R, Ennis K-A, Tymko KS, Hurrie DMG, McDonald GK, Cornish SM, Giesbrecht GG. Skin cooling on breath-hold duration and predicted emergency air supply duration during immersion. Aerosp Med Hum Perform. 2020; 91(7):578-585.

Eight weeks of static apnea training increases spleen volume but not acute spleen contraction

Splenic contraction is an important response to acute apnea causing the release of red blood cells into blood circulation. Current literature shows higher spleen volumes and greater spleen contractions in trained apnea divers compared to untrained individuals, but the influence of training is presently unknown.Thirteen subjects daily performed five static apneas for 8 weeks. Before, halfway through and after the apnea training period, subjects performed five maximal breath-holds at the laboratory. Baseline values for and changes in splenic volume and hemoglobin ([Hb]) were assessed. Although baseline spleen volume had increased (from 241 ± 55 mL PRE to 299 ± 51 mL POST training, p = 0.007), the absolute spleen contraction (142 ± 52 mL PRE and 139 ± 34 mL POST training, p = 0.868) and the acute increase in [Hb] remained unchanged.The present study shows that apnea training can increase the size of the spleen but that eight weeks of training is not sufficient to elicit significant training adaptations on the acute response.

Physiology of static breath holding in elite apneists.

What is the topic of this review? This review provides an up-to-date assessment of the physiology involved with extreme static dry-land breath holding in trained apneists. What advances does it highlight? We specifically highlight the recent findings involved with the cardiovascular, cerebrovascular and metabolic function during a maximal breath hold in elite apneists. Breath-hold-related activities have been performed for centuries, but only recently, within the last ∼30years, has it emerged as an increasingly popular competitive sport. In apnoea sport, competition relates to underwater distances or simply maximal breath-hold duration, with the current (oxygen-unsupplemented) static breath-hold record at 11min35s. Remarkably, many ultra-elite apneists are able to suppress respiratory urges to the point where consciousness fundamentally limits a breath-hold duration. Here, arterial oxygen saturations as low as ∼50% have been reported. In such cases, oxygen conservation to maintain cerebral functioning is critical, where responses ascribed to the mammalian dive reflex, e.g. sympathetically mediated peripheral vasoconstriction and vagally mediated bradycardia, are central. In defence of maintaining global cerebral oxygen delivery during prolonged breath holds, the cerebral blood flow may increase by ∼100% from resting values. Interestingly, near the termination of prolonged dry static breath holds, recent studies also indicate that reductions in the cerebral oxidative metabolism can occur, probably attributable to the extreme hypercapnia and irrespective of the hypoxaemia. In this review, we highlight and discuss the recent data on the cardiovascular, metabolic and, particularly, cerebrovascular function in competitive apneists performing maximal static breath holds. The physiological adaptation and maladaptation with regular breath-hold training are also summarized, and future research areas in this unique physiological field are highlighted; particularly, the need to determine the potential long-term health impacts of extreme breath holding.

Influence of lung volume on the interaction between cardiac output and cerebrovascular regulation during extreme apnoea

What is the central question of this study? Does the reduction in cardiac output observed during extreme voluntary apnoea, secondary to high lung volume, result in a reduction in cerebral blood flow, perfusion pressure and oxygen delivery in a group of elite free divers? What is the main finding and its importance? High lung volumes reduce cardiac output and ventricular filling during extreme apnoea, but changes in cerebral blood flow are observed only transiently during the early stages of apnoea. This reveals that whilst cardiac output is important in regulating cerebral haemodynamics, the role of mean arterial pressure in restoring cerebral perfusion pressure is of greater significance to the regulation of cerebral blood flow. We investigated the role of lung volume-induced changes in cardiac output (Q̇) on cerebrovascular regulation during prolonged apnoea. Fifteen elite apnoea divers (one female; 185±7cm, 82±12kg, 29±7years old) attended the laboratory on two separate occasions and completed maximal breath-holds at total lung capacity (TLC) and functional residual capacity (FRC) to elicit disparate cardiovascular responses. Mean arterial pressure (MAP), internal jugular venous pressure and arterial blood gases were measured via cannulation. Global cerebral blood flow was quantified by ultrasound and cardiac output was quantified by via photoplethysmography. At FRC, stroke volume and Q̇ did not change from baseline (P>0.05). In contrast, during the TLC trial stroke volume and Q̇ were decreased until 80 and 40% of apnoea, respectively (P<0.05). During the TLC trial, global cerebral blood flow was significantly lower at 20%, but subsequently increased so that cerebral oxygen delivery was comparable to that during the FRC trial. Internal jugular venous pressure was significantly higher throughout the TLC trial in comparison to FRC. The MAP increased progressively in both trials but to a greater extent at TLC, resulting in a comparable cerebral perfusion pressure between trials by the end of apnoea. In summary, although lung volume has a profound effect on Q̇ during prolonged breath-holding, these changes do not translate to the cerebrovasculature owing to the greater sensitivity of cerebral blood flow to arterial blood gases and MAP; regulatory mechanisms that facilitate the maintenance of cerebral oxygen delivery.

Deep inspirational breath hold to reduce cardiac dose in left-sided breast radiotherapy

AbstractBackgroundDuring left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.Materials and methodsIn total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.ResultsThe median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.ConclusionABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.

Quantifying cerebrovascular reactivity in anterior and posterior cerebral circulations during voluntary breath holding.

What is the central question of this study? We developed and validated a 'stimulus index' (SI; ratio of end-tidal partial pressures of CO2 and O2 ) method to quantify cerebrovascular reactivity (CVR) in anterior and posterior cerebral circulations during breath holding. We aimed to determine whether the magnitude of CVR is correlated with breath-hold duration. What is the main finding and its importance? Using the SI method and transcranial Doppler ultrasound, we found that the magnitude of CVR of the anterior and posterior cerebral circulations is not positively correlated with physiological or psychological break-point during end-inspiratory breath holding. Our study expands the ability to quantify CVR during breath holding and elucidates factors that affect break-point. The central respiratory chemoreflex contributes to blood gas homeostasis, particularly in response to accumulation of brainstem CO2 . Cerebrovascular reactivity (CVR) affects chemoreceptor stimulation inversely through CO2 washout from brainstem tissue. Voluntary breath holding imposes alterations in blood gases, eliciting respiratory chemoreflexes, potentially contributing to breath-hold duration (i.e. break-point). However, the effects of cerebrovascular reactivity on break-point have yet to be determined. We tested the hypothesis that the magnitude of CVR contributes directly to breath-hold duration in 23 healthy human participants. We developed and validated a cerebrovascular stimulus index methodology [SI; ratio of end-tidal partial pressures of CO2 and O2 (P ET ,CO2/P ET ,O2)] to quantify CVR by correlating measured and interpolated values of P ET ,CO2 (r=0.95, P<0.0001), P ET ,O2 (r=0.98, P<0.0001) and SI (r=0.94, P<0.0001) during rebreathing. Using transcranial Doppler ultrasound, we then quantified the CVR of the middle (MCAv) and posterior (PCAv) cerebral arteries by plotting cerebral blood velocity against interpolated SI during a maximal end-inspiratory breath hold. The MCAv CVR magnitude was larger than PCAv (P=0.001; +70%) during breath holding. We then correlated MCAv and PCAv CVR with the physiological (involuntary diaphragmatic contractions) and psychological (end-point) break-point, within individuals. There were significant inverse but modest relationships between both MCAv and PCAv CVR and both physiological and psychological break-points (r<-0.53, P<0.03). However, these relationships were absent when MCAv and PCAv cerebrovascular conductance reactivity was correlated with both physiological and psychological break-points (r>-0.42; P>0.06). Although central chemoreceptor activation is likely to be contributing to break-point, our data suggest that CVR-mediated CO2 washout from central chemoreceptors plays no role in determining break-point, probably because of a reduced arterial-to-tissue CO2 gradient during breath holding.

Role of cerebral blood flow in extreme breath holding.

The role of cerebral blood flow (CBF) on a maximal breath-hold (BH) in ultra-elite divers was examined. Divers (n = 7) performed one control BH, and one BH following oral administration of the non-selective cyclooxygenase inhibitor indomethacin (1.2 mg/kg). Arterial blood gases and CBF were measured prior to (baseline), and at BH termination. Compared to control, indomethacin reduced baseline CBF and cerebral delivery of oxygen (CDO2) by about 26% (p < 0.01). Indomethacin reduced maximal BH time from 339 ± 51 to 319 ± 57 seconds (p = 0.04). In both conditions, the CDO2 remained unchanged from baseline to the termination of apnea. At BH termination, arterial oxygen tension was higher following oral administration of indomethacin compared to control (4.05 ± 0.45 vs. 3.44 ± 0.32 kPa). The absolute increase in CBF from baseline to the termination of apnea was lower with indomethacin (p = 0.01). These findings indicate that the impact of CBF on maximal BH time is likely attributable to its influence on cerebral H+ washout, and therefore central chemoreceptive drive to breathe, rather than to CDO2.

The ins and outs of breath holding: simple demonstrations of complex respiratory physiology.

The physiology of breath holding is complex, and voluntary breath-hold duration is affected by many factors, including practice, psychology, respiratory chemoreflexes, and lung stretch. In this activity, we outline a number of simple laboratory activities or classroom demonstrations that illustrate the complexity of the integrative physiology behind breath-hold duration. These activities require minimal equipment and are easily adapted to small-group demonstrations or a larger-group inquiry format where students can design a protocol and collect and analyze data from their classmates. Specifically, breath-hold duration is measured during a number of maneuvers, including after end expiration, end inspiration, voluntary prior hyperventilation, and inspired hyperoxia. Further activities illustrate the potential contribution of chemoreflexes through rebreathing and repeated rebreathing after a maximum breath hold. The outcome measures resulting from each intervention are easily visualized and plotted and can comprise a comprehensive data set to illustrate and discuss complex and integrated cardiorespiratory physiology.

Breath‐Holding: Simple Demonstrations of Complex Physiology

The complex interaction of chemical (i.e. chemoreceptors) and mechanical (i.e. lung‐stretch receptors) factors influences breath‐holding (BH). The aim of this project was to develop a simple set of procedures to be used as class‐room demonstrations or laboratory exercises to differentiate the roles of chemical and mechanical mechanisms in regulating BH.The increase in ventilation during rebreathing (plastic bag) was initially used to demonstrate the progressive increase in drive to breathe due to chemical factors. BH time (stopwatch) was also used as a quantifiable and intuitive metric of drive to breathe. Maximal BH's were conducted under the following conditions: 1) end‐expiratory BH (lung stretch receptor unloading), 2) end‐inspiratory BH (lung stretch receptor loading), 3) BH following 30s of hyperventilation (reduces pCO2 &amp; isolates the influence of decreased pO2), and 4) BH following 5 breaths of pure oxygen (elevates pO2 &amp; isolates the influence of increased pCO2). Using the end‐expiratory BH as the standard, students observed the increase in BH time with each of the other 3 maneuvers. An advanced critical thinking procedure was also introduced whereby students rebreathed in and out of a bag twice at the end of a maximal BH before attempting to hold their breath again. This procedure highlights the powerful suppression of drive to breathe by lung‐stretch receptors despite elevated chemical drive to breathe.These procedures represent a simple method to highlight complex physiological mechanisms which contribute to the drive to breathe. Such simple activities are suitable and adaptable for use across a range of physiology curricula and teaching settings.

Hypercapnic Ventilatory Response: A Comparison Between Elite and Novice Skin Divers

This study tested whether hypercapnic ventilatory response (HCVR) is affected by experience in apnoea and explored the possible underlying mechanisms of this phenomenon, with reference to maximum breath hold time (BHT). Elite apnoea divers (EBH=11) and novice subjects (NBH=10) performed a HCVR test (BM), which was repeated by the latter group on another day (PRE) after subjects executed five repeated maximum apnoeas. Subsequently, after a two week period of daily apnoea training, NBH subjects repeated HCVR test (POST). Diaphragmatic activity was recorded to determine apnoea easy going phase. Baseline HCVR of EBH was not lower than that of NBH. After execution of five apnoeas, HCVR in EBH decreased (P≤0.05) whereas it was not different among BM, PRE, and POST conditions in the NBH. Higher BHT and easy going phase values ensued from apnoea maneuvers in EBH than in NBH (PRE and POST), and in NBH POST compared to PRE condition (P≤0.05). HCVR was highly correlated (P≤0.05) with the cumulative easy going phase in EBH, PRE condition but nothing-similar observed in NBH, neither in PRE nor in POST conditions. These results indicate that at rest HCVR is not lower in experienced, than novice, skin divers; this response becomes dull after five repeated maximum apnoeas only in EBH. In the NBH group, two weeks of apnoea training are not adequate to affect HCVR despite an increase of BHT. It appears that after a repeated maximum apnoeas maneuver experienced skin divers improve BHT by extending easy going phase whereas NBH by other means.

Breath-hold diving as a brain survival response

AbstractElite breath-hold divers are unique athletes challenged with compression induced by hydrostatic pressure and extreme hypoxia/hypercapnia during maximal field dives. The current world records for men are 214 meters for depth (Herbert Nitsch, No-Limits Apnea discipline), 11:35 minutes for duration (Stephane Mifsud, Static Apnea discipline), and 281 meters for distance (Goran Čolak, Dynamic Apnea with Fins discipline). The major physiological adaptations that allow breath-hold divers to achieve such depths and duration are called the “diving response” that is comprised of peripheral vasoconstriction and increased blood pressure, bradycardia, decreased cardiac output, increased cerebral and myocardial blood flow, splenic contraction, and preserved O2 delivery to the brain and heart. This complex of physiological adaptations is not unique to humans, but can be found in all diving mammals. Despite these profound physiological adaptations, divers may frequently show hypoxic loss of consciousness. The breath-hold starts with an easy-going phase in which respiratory muscles are inactive, whereas during the second so-called “struggle” phase, involuntary breathing movements start. These contractions increase cerebral blood flow by facilitating left stroke volume, cardiac output, and arterial pressure. The analysis of the compensatory mechanisms involved in maximal breath-holds can improve brain survival during conditions involving profound brain hypoperfusion and deoxygenation.

Baseline plasma cGMP levels correlates with breath hold capacity in competitive breath hold divers

Breath‐hold (BH) duration depends on oxygen stores and consumption. Strong peripheral vasoconstriction and reduction in cardiac output (diving response) reduce oxygen consumption during apnea. A healthy reactive endothelium may be important for an efficient diving response. Endothelium‐derived nitric oxide (NO) is deeply involved in endothelial function and plasma cGMP is considered as a marker of endothelial NO synthase activity.ObjectiveTo evaluate the association between plasma cGMP and BH capacity in trained BH divers.MethodsNine BH divers performed BHs of maximal duration after inhalation to 80% of vital capacity. Oxygen consumption was evaluated with pulse oximetry (SpO2) and exhaled O2 fraction (EtFO2) at end of apnea. Baseline plasma cGMP was measured before and 10min after the apnea protocol.ResultsA strong positive correlation was found between baseline plasma cGMP levels and maximum BH duration (344±13 sec, R2=0.63, P=0.011), SpO2 at 4min (R2=0.53, P=0.026) and EtFO2 at breath‐holds aborted at 4min (R2=0.50, P=0.026). Mean plasma cGMP increased from 4.3±0.8 to 7,8±1.8nM as a result of the apnea protocol (P=0.024).ConlusionBaseline plasma cGMP predicts breath hold capacity and oxygen consumption during apnea in trained breath hold divers. This indicates that endothelial NOS activity could be important in the vascular part of the diving response.

Non-invasive monitoring of blood gas-induced changes of myocardial oxygenation using oxygen-sensitive CMR

Summary BOLD-CMR was used to assess changes in myocardial oxygenation after volunteers performed controlled hyperventilation or breath holding. Signal intensity after hyperventilation decreased whereas an increase occurred after a breath hold demonstrating that controlled breathing techniques could alter myocardial oxygenation and be identified by BOLD-CMR in healthy volunteers. Background Systemic changes of blood gases (CO2 ,O 2) affect haemoglobin (Hb) saturation. Blood Oxygen Level-Dependent (BOLD-) CMR can be used to monitor changes of myocardial oxygenation. We hypothesized that oxygensensitive CMR detects changes in myocardial tissue oxygenation induced by hyperventilation and apnea. Methods A group of 7 healthy volunteers were instructed to hyperventilate for 1 and 2 minutes followed by a long free breath hold. A second group of 5 aquatic athletes performed a 60s breath hold and a free maximal breath hold. BOLD-sensitive SSFP cines were acquired during breath holds as well as before and after hyperventilation. Changes in signal intensity over the procedures were expressed as % change of the baseline. Capillary blood gases were measured prior to and after the procedures. Results Voluntary breath holds of athletes were significantly longer (105±38s) than those of other volunteers (38 ±12s). Breath holds lead to a significant increase in signal intensity (*p<0.001), correlated with the length of breath hold (R=0.566, *p=0.018). Capillary pCO2 did not change during breath holds, while pO2 increased during shorter breath holds of 38s (+8.8 mmHg, *p=0.03) and decreased in long breath holds of 105s (-14.5mmHg, *p=0.03). On the other hand, hyperventilation resulted in a significant decrease of myocardial signal intensity, associated with a decrease of capillary pCO2 of 5.9 mmHg during 1 min of hyperventilation (*p<0.001) and 8.7 mmHg during a 2 min hyperventilation period (*p<0.001). Capillary pO2 was not altered by hyperventilation. Conclusions Our results demonstrate that BOLD-CMR can identify changes in myocardial oxygenation induced by controlled breathing maneuvers.