Received September 14, 2005
Revised October 6, 2005
Accepted after revision November 7, 2005

¹ UMDNJ

^* To whom correspondence should be addressed. E-mail: cherniack{at}njneuromed.org.

	Abstract

Summary Periodic breathing is an unusual form of breathing with oscillations in minute ventilations and with repetitive apneas or near apneas. Reported initially in patients with heart failure or stroke, it was later recognized to occur especially during sleep. The recurrent hypoxia and surges of sympathetic activity that often occur during the apneas have serious health consequences. Mathematical models have helped greatly in the understanding of the causes of recurrent apneas. It is unlikely that every instance of periodic breathing has the same cause but many are due to instability in the feed back control involved in the chemical regulation of breathing caused by increased controller and plant gains and delays in information transfer. Even when it is not the main cause of the periodic breathing, unstable control modifies the ventilatory pattern and sometimes intensifies the recurrent apneas. The characteristics of disturbances to breathing and their interaction with the control system can be critical in determining ventilation responses and the occurrence of periodic breathing. Large abrupt changes in ventilation produced for example in the transition from waking to sleep and vice versa, or in the transitions from breathing to apnea are potent factors causing periodic breathing. Mathematical models show that periodic breathing is a "systems disorder" produced by the interplay of multiple factors. Multiple factors contribute to the occurrence of periodic breathing in congestive heart failure and cerebrovascular disease, increasing treatment options.

Key Words: Breathing, Hypoxia, Respiratory control

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