Respiratory Dysfunction and Abnormal Hypoxic Ventilatory Response in Mild to Moderate Parkinson's Disease

Abstract

Background: Respiratory dysfunction is an important contributor to morbidity and mortality in advanced Parkinson's disease (PD), but it is unclear what parameters are sensitive to diagnose and monitor respiratory dysfunction across disease phases.

Objectives: We aimed to characterize respiratory dysfunction in mild to moderate PD.

Methods: In 20 individuals without cardiopulmonary comorbidity, pulmonary and inspiratory muscle function testing were performed ON-medication. Subsequently, the acute ventilatory response to hypoxia (HVR) was assessed by gradually decreasing F_IO₂ from 0.209 (room air) to 0.127, which was compared to eight age- and sex-matched healthy controls under arterial blood gas monitoring. Lastly, on different days, the same 20 individuals with PD underwent six blinded exposures to 45-min normobaric hypoxia at FiO2 0.163 and 0.127 or placebo OFF-medication to assess breathing responses.

Results: At rest, individuals with greatest PD severity had a lower tidal volume (pairwise comparisons: 0.59 vs. 0.74, P = 0.038-0.050) and tended to have a higher breathing frequency (17.7 vs. 14.4, P = 0.076), despite normal pulmonary function. A 45-min exposure to hypoxia induced a significantly lower acute HVR in individuals with PD compared to controls (-0.0489 vs. 0.133 L.min/%, P = 0.0038). Acute HVR was reduced regardless of disease severity. Subacute HVR in individuals with milder disease tended to be higher compared to those with more advanced disease (P = 0.079).

Conclusions: Respiratory dysfunction is present in individuals with PD, including those with relatively mild disease severity, and is characterized by altered breathing patterns at rest, as well as a lower HVR, despite normal pulmonary and inspiratory muscle function testing.

Keywords: Parkinson's disease; breathing; hypoxia; pneumonia; respiratory dysfunction.

Figure 1

Flowchart of participant selection.

Figure 2

Difference in hypoxic ventilatory response (P = 0.0038) between participants with PD (N = 18) and controls (n = 8), as illustrated by the relation between peripheral oxygen saturation (SpO₂) and ventilation (V_E) at F_IO₂ levels of 0.209 (room air), 0.163, 0.15, 0.138 and 0.127 (or 0.133 when SpO₂ reaches 80% before F_IO₂ 0.127). Horizontal error bars reflect the distribution of SpO₂ values at every F_IO₂ level.