Hypoxemia increases blood-brain barrier permeability during extreme apnea in humans

Damian Bailey, Anthony R. Bain, Ryan L. Hoiland, Otto F. Barak, Ivan Drvis, Christophe Hirtz, Sylvain Lehmann, Nicola Marchi, Damir Janigro, David B. MacLeod, Philip Ainslie, Željko Dujić

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Voluntary asphyxia imposed by static apnea challenges blood-brain barrier (BBB) integrity in humans through transient extremes of hypertension, hypoxemia and hypercapnia. In the present study, ten ultra-elite breath-hold divers performed two maximal dry apneas preceded by normoxic normoventilation (NX: severe hypoxemia and hypercapnia) and hyperoxic hyperventilation (HX: absence of hypoxemia with exacerbating hypercapnia) with measurements obtained before and immediately after apnea. Transcerebral exchange of NVU proteins (ELISA, Single Molecule Array) were calculated as the product of global cerebral blood flow (gCBF, duplex ultrasound) and radial arterial to internal jugular venous concentration gradients. Apnea duration increased from 5 m 6 s in NX to 15 m 59 s in HX (P =
Original languageEnglish
Pages (from-to)1120-1135
Number of pages16
JournalJournal of Cerebral Blood Flow and Metabolism
Issue number6
Early online date21 Jan 2022
Publication statusPublished - 11 Apr 2022


  • Hypoxia
  • blood-brain barrier
  • cerebral blood flow
  • hypercapnia
  • hyperoxia


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