Kohlendioxid und Schlaf

In acute and intensive care medicine in particular, the determination of the partial pressure of carbon dioxide (paCO₂) in conjunction with the determination of the acid-base balance has become a central component in diagnostics and therapy. Carbon dioxide (CO₂) plays a decisive role in respiratory regulation. However, there are still controversial opinions regarding the significance of a chronic compensated CO₂ increase in the body. Is the increase in CO₂ only a surrogate parameter, or does chronic CO₂ accumulation also have direct metabolic effects with serious negative consequences for the organism?

In this article, fundamental questions of respiratory regulation and the effects of changes in CO₂ homeostasis in the organism are presented, with a focus on the relationship between CO₂ and sleep. Furthermore, interesting current experimental studies on carbon dioxide therapy are presented.

Changes in carbon dioxide levels are also especially important during sleep and in sleep apnea. Due to the physiological changes during sleep, maintaining gas exchange is also a major challenge for patients with underlying lung pathology.

Carbon dioxide plays a crucial role in respiratory regulation during wakefulness and sleep, whereby the respiratory response to paCO₂ changes is reduced during sleep. Therefore, sleep appears to be a particularly critical phase for the development of alveolar hypoventilation, even in patients with lung disease, and diagnostics should definitely include gas exchange during sleep, for example with transcutaneous CO₂ measurement. The standard procedure for the treatment of hypoventilation or hypercapnia is the initiation of continuous positive pressure therapy (CPAP) or non-invasive ventilation (NIV). The aim of the therapy should always be to achieve a relevant reduction or normalization of the carbon dioxide level.