CONTROL OF BREATHING DURING SLEEP

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Abstract
A number of broad conclusions regarding breathing during sleep emerge from the advances made in this field during the past few years. Sleep is not a homogeneous state, nor is respiratory control during sleep attributable to a single control system. Observations of breathing made in the anesthetized or awake state cannot necessarily be extrapolated to the sleeping state. The conclusion that respiratory control during sleep cannot be reliably investigated from studies during wakefulness may apply even more to disorders of the system than it does to normal function. Indeed, the few studies to date in patients with disorders of the respiratory control system or of the ventilatory apparatus indicate that changes in ventilation and gas exchange during sleep cannot be reliably predicted by clinical or laboratory investigation during wakefulness. A variety of clinical signs and symptoms, such as nocturnal insomnia or daytime sleepiness, that may not on the surface suggest a relationship to disturbances of breathing during sleep, may nevertheless be due to such a disorder. Studies of respiratory control during sleep in health have not only provided a basis for elucidation of the mechanisms involved in disease, but have also advanced understanding of respiratory control in general.