The Impact of Sleep Deprivation on the Respiratory Muscles

Am J Respir Crit Care Med

  •  2020 Apr 15;201(8):976-983.

 doi: 10.1164/rccm.201904-0819OC.

Impact of Sleep Deprivation on Respiratory Motor Output and Endurance. A Physiological Study

Christophe Rault 1 2Aude Sangaré 3Véronique Diaz 1 2Stéphanie Ragot 1 4Jean-Pierre Frat 1 5Mathieu Raux 6 7Thomas Similowski 6 8René Robert 1 5Arnaud W Thille 1 5Xavier Drouot 1 2 3 9

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Rationale: Sleep deprivation can alter endurance of skeletal muscles, but its impact on respiratory command is unknown.

Objectives: We aimed to assess the effect of sleep deprivation on respiratory motor output and inspiratory endurance.

Methods: Inspiratory endurance was investigated twice in random order, following a normal sleep night and a sleepless night. Healthy participants were asked to breathe as long as possible until task failure against a moderate inspiratory threshold constraint. Transdiaphragmatic pressure and diaphragm electrical activity were measured throughout the trial to assess pressure output of the diaphragm and overall respiratory motor output. Cortical contribution to respiratory motor output was assessed by measurement of preinspiratory motor potential amplitude and by cervical magnetic simulation

.Measurements and Main Results: Twenty healthy male participants were studied. Time to task failure was significantly shorter after sleep deprivation than after normal sleep: (30 min [interquartile range [IQR], 17-41] vs. 60 min [IQR, 45-60], P = 0.002). At the beginning of the trial, preinspiratory motor potential amplitude was significantly lower in the sleep-deprivation condition (4.5 μV [IQR, 2.5-6.4] vs. 7.3 μV [IQR, 4.3-10.4], P = 0.02) and correlated significantly with the duration of the endurance trial. In the sleep-deprivation condition, preinspiratory motor potential amplitude, electrical activity of the diaphragm, pressure output of the diaphragm, and Vt decreased and the respiratory rate increased significantly from the beginning to the end of the trial. Such decreases did not occur in the normal-sleep condition

.Conclusions:  One night of sleep deprivation reduces respiratory motor output by altering its cortical component with subsequent reduction of inspiratory endurance by half. These results suggest that altered sleep triggers severe brain dysfunctions that could precipitate respiratory failure.

and in people with abnormal daytime baseline respiratory rates and possibly abnormal reflexes to hypercapnia, ….sleep deprivation will have a greater risk of precipitating respiratory failure and the neurotoxic effects if cumulative hypercapnia, hypocapnia and/or intermittent hypoxia.

It all makes sense now.

Kraepelin would not have been surprised, he anticipated something like this, over 100 years ago. It was obvious to him that abnormal blood gases were causing neurotoxic symptoms in bipolar patients, once he discovered that baseline respiratory rates were abnormal in bipolar patients.

It is obvious to anyone who bothers to measure the vital signs – vital signs vital to sanity, as well as to staying alive.

And today, we have modern supportive medical tools to restore these patients to their baseline normal function by helping them to breathe…if we wish to….if we consider what Kraepelin found long ago and what current researchers are finding now.

Depression ,Mania, Cognitive impairment, Psychosis….these are Neuro-toxic symptoms; same as the Neuro-toxic symptoms seen with external poisons and intoxicants……BUT here the Neuro-toxic symptoms are due to failure of some body system. In the case of bipolar illness, the system involved is the “control of breathing” and skeletal ventilatory failure.

to be continued.


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