title: Neurophysiological Evidence for a Cortical Contribution to the Wakefulness-Related Drive to Breathe Explaining Hypocapnia-Resistant Ventilation in Humans.
abstract: Spontaneous ventilation in mammals is driven by automatic brainstem networks that generate the respiratory rhythm and increase ventilation in the presence of increased carbon dioxide production. Hypocapnia decreases the drive to breathe and induces apnea. In humans, this occurs during sleep but not during wakefulness. We hypothesized that hypocapnic breathing would be associated with respiratory-related cortical activity similar to that observed during volitional breathing, inspiratory constraints, or in patients with defective automatic breathing (preinspiratory potentials). Nineteen healthy subjects were studied under passive (mechanical ventilation, n = 10) or active (voluntary hyperventilation, n = 9) profound hypocapnia. Ventilatory and electroencephalographic recordings were performed during voluntary sniff maneuvers, normocapnic breathing, hypocapnia, and after return to normocapnia. EEG recordings were analyzed with respect to the ventilatory flow signal to detect preinspiratory potentials in frontocentral electrodes and to construct time-frequency maps. After passive hyperventilation, hypocapnia was associated with apnea in 3 cases and ventilation persisted in 7 cases (3 and 6 after active hyperventilation, respectively). No respiratory-related EEG activity was observed in subjects with hypocapnia-related apneas. In contrast, preinspiratory potentials were present at vertex recording sites in 12 of the remaining 13 subjects (p < 0.001). This was corroborated by time-frequency maps. This study provides direct evidence of a cortical substrate to hypocapnic breathing in awake humans and fuels the notion of corticosubcortical cooperation to preserve human ventilation in a variety of situations. Of note, maintaining ventilatory activity at low carbon dioxide levels is among the prerequisites to speech production insofar as speech often induces hypocapnia.
  
  
  
  Human ventilatory activity persists, during wakefulness, even when hypocapnia makes it unnecessary. This peculiarity of human breathing control is important to speech and speech-breathing insofar as speech induces hypocapnia. This study evidences a specific respiratory-related cortical activity. This suggests that human hypocapnic breathing is driven, at least in part, by cortical mechanisms similar to those involved in volitional breathing, in breathing against mechanical constraints or with weak inspiratory muscle, and in patients with defective medullary breathing pattern generators. This fuels the notion that the human ventilatory drive during wakefulness often results from a corticosubcortical cooperation, and opens new avenues to study certain ventilatory and speech disorders.
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale Département R3S, F-75013 Paris, France.
authors.forename: Matthieu
authors.identifier: 0000-0002-0547-8236
authors.initials: M
authors.lastname: Dubois
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale Département R3S, F-75013 Paris, France.
authors.forename: Cécile
authors.identifier: 0000-0002-6229-2075
authors.initials: C
authors.lastname: Chenivesse
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie-Réanimation, F-75013 Paris, France, and.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Raux
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France.
authors.forename: Adrian
authors.initials: A
authors.lastname: Morales-Robles
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France.
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Nierat
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France.
authors.forename: Gilles
authors.identifier: 0000-0001-5383-4189
authors.initials: G
authors.lastname: Garcia
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Institut du Cerveau et de la Moëlle, F-75013 Paris, France.
authors.forename: Xavier
authors.identifier: 0000-0002-6814-5279
authors.initials: X
authors.lastname: Navarro-Sune
authors.affiliation: Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Institut du Cerveau et de la Moëlle, F-75013 Paris, France.
authors.forename: Mario
authors.initials: M
authors.lastname: Chavez
authors.affiliation: Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Institut du Cerveau et de la Moëlle, F-75013 Paris, France.
authors.forename: Jacques
authors.identifier: 0000-0002-7031-4940
authors.initials: J
authors.lastname: Martinerie
authors.affiliation: Sorbonne Université, Université Paris 06 Pierre et Marie Curie and Institut National de la Santé et de la Rercherche Médicale, Unité Mixte de Recherche-Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75013 Paris, France, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale Département R3S, F-75013 Paris, France, thomas.similowski@psl.aphp.fr.
authors.forename: Thomas
authors.identifier: 0000-0003-2868-9279
authors.initials: T
authors.lastname: Similowski
mesh_terms: D001931:Brain Mapping; D002245:Carbon Dioxide / Q000378:metabolism; D002540:Cerebral Cortex / Q000503:physiopathology*; D004328:Drive; D004569:Electroencephalography; D005260:Female; D006801:Humans; D016857:Hypocapnia / Q000503:physiopathology*; D008297:Male; D012119:Respiration; D012121:Respiration, Artificial; D012890:Sleep; D014851:Wakefulness; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide
keywords: cerebral cortex; control of breathing; hypocapnia; respiration