Respiratory physiology & neurobiology · 2026
Daytime CO₂ normalization with home ventilation in neuromuscular disease: No improvement in central respiratory drive.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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De Vito Eduardo Luis, Arce Santiago Cruz, Monteiro Sergio Gabriel
Аннотация
BACKGROUND: Chronic hypoventilation is common in individuals with neuromuscular disease (NMD). Nocturnal noninvasive home mechanical ventilation (NIHMV) reduces daytime PaCO2, but the underlying mechanism remains unclear.
OBJECTIVE: To evaluate the impact of NIHMV on central respiratory drive in individuals with NMD whose daytime PaCO2 decreases following ventilation.
METHODS: A prospective, longitudinal observational study was conducted in adults with NMD and chronic hypoventilation receiving usual clinical care. Central respiratory drive was assessed using CO₂ rebreathing and compared with healthy controls. Airway occlusion pressure (P0.1) was related to PETCO₂ during rebreathing to calculate the P0.1/PETCO₂ slope. Recruitment reflected real-world clinical practice, and data were analyzed post hoc.
RESULTS: P0.1/PETCO₂ slopes were obtained in all 20 individuals at the six-month post-NIHMV evaluation; eight individuals subsequently completed a third CO₂ rebreathing assessment at 24 months. Baseline PaCO₂ (55.1 ± 8.2 mmHg) normalized post-NIHMV (p < 0.001), whereas the P0.1/PETCO₂ slope remained unchanged (p = 0.338). The median slope in the NMD group was 0.011 (0.004-0.030), compared with 0.187 (0.150-0.244) in controls (p < 0.001). Breath-holding time was prolonged in 17 individuals and remained stable throughout the follow-up.
CONCLUSIONS: Consistent with previous studies, NIHMV can normalize daytime PaCO₂ in individuals with NMD. In those who achieved PaCO₂ normalization, no improvement in central respiratory drive was observed. The unchanged P0.1/PETCO₂ slope indicates that daytime PaCO₂ normalization is unlikely to be mediated by enhanced central chemosensitivity. Further studies are needed to clarify the physiological mechanisms responsible for hypercapnia correction with NIHMV.
OBJECTIVE: To evaluate the impact of NIHMV on central respiratory drive in individuals with NMD whose daytime PaCO2 decreases following ventilation.
METHODS: A prospective, longitudinal observational study was conducted in adults with NMD and chronic hypoventilation receiving usual clinical care. Central respiratory drive was assessed using CO₂ rebreathing and compared with healthy controls. Airway occlusion pressure (P0.1) was related to PETCO₂ during rebreathing to calculate the P0.1/PETCO₂ slope. Recruitment reflected real-world clinical practice, and data were analyzed post hoc.
RESULTS: P0.1/PETCO₂ slopes were obtained in all 20 individuals at the six-month post-NIHMV evaluation; eight individuals subsequently completed a third CO₂ rebreathing assessment at 24 months. Baseline PaCO₂ (55.1 ± 8.2 mmHg) normalized post-NIHMV (p < 0.001), whereas the P0.1/PETCO₂ slope remained unchanged (p = 0.338). The median slope in the NMD group was 0.011 (0.004-0.030), compared with 0.187 (0.150-0.244) in controls (p < 0.001). Breath-holding time was prolonged in 17 individuals and remained stable throughout the follow-up.
CONCLUSIONS: Consistent with previous studies, NIHMV can normalize daytime PaCO₂ in individuals with NMD. In those who achieved PaCO₂ normalization, no improvement in central respiratory drive was observed. The unchanged P0.1/PETCO₂ slope indicates that daytime PaCO₂ normalization is unlikely to be mediated by enhanced central chemosensitivity. Further studies are needed to clarify the physiological mechanisms responsible for hypercapnia correction with NIHMV.