Sex Influence on Trigeminal Nerve Stimulation and Breath-Hold Diving Performance: Examination of the Autonomic Regulation of Cardiovascular Responses to Facial Cooling and Apnoea Across Sex and Varied Factors

Abstract

This review emphasises the importance of the cardiovascular response to facial cooling (FC) and breath holding in both sexes. The trigemino-cardiac reflex, triggered by FC, reduces heart rate (HR) and constricts blood vessels. When combined with breath holding, this effect intensifies, enhancing the cardiodepressive impact. The cardiovascular reaction to this combination, known as the cold-water face immersion or simulated diving test, varies among individuals and depends on their cardiovascular regulatory profiles, which differ between men and women. Despite extensive research on the cardiovascular response to FC and apnoea, most studies did not categorise participants by sex, leading to a limited understanding of how it influences trigeminal nerve stimulation (TGS) and breath-hold diving (BHD). Despite attempts to address this, the existing findings remain inconsistent due to intra- and inter-individual variability. Key factors influencing the diving response include the influence of the parasympathetic system on HR, vascular sympathetic activity affecting total peripheral resistance (TPR), sensitivity to CO₂, lung capacity, training, physical performance, duration of apnoea, and the stimulation of metaboreceptors in working muscles. These factors differ between men and women, potentially contributing to variations in the effectiveness of the response to the FC combined with breath holding.

Keywords: autonomic nervous system (ANS); breath-hold diving (BHD); diving response; trigeminal nerve stimulation (TGS).