Noninvasive assessment of cardiovascular autonomic control in congenital central hypoventilation syndrome

Abstract

The goal of this study was to quantify autonomic system dysfunction, as manifested by cardiovascular and respiratory response abnormalities, in patients with congenital central hypoventilation syndrome (CCHS). During wakefulness, we continuously measured the ECG, arterial blood pressure (ABP), airflow, end-tidal CO2 partial pressure (PETCO2), and arterial oxygen saturation (SatO2) in each subject. These measurements were made during spontaneous breathing in supine, sitting and standing postures, and also when each subject tracked his/her prior spontaneous breathing pattern while supine. We also performed the cold face test, hyperoxic hypercapnic rebreathing and the isocapnic hypoxic rebreathing challenges. Using spectral analysis and modeling techniques, we sought to computationally delineate the physiological mechanisms that mediate these abnormalities, as well as to determine the extent to which these abnormalities are related to peripheral or central chemoreflex dysfunction. Our preliminary results support the notion that sympathetic tone is markedly elevated in CCHS, and that differences in autonomic control from normal controls can be delineated by observing the responses to different stressors.