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In apnoea sport, competition relates to underwater distances or simply maximal breath\u2010hold duration, with the current (oxygen\u2010unsupplemented) static breath\u2010hold record at 11\u00a0min\u00a035\u00a0s. Remarkably, many ultra\u2010elite apneists are able to suppress respiratory urges to the point where consciousness fundamentally limits a breath\u2010hold duration. Here, arterial oxygen saturations as low as \u223c50% have been reported. In such cases, oxygen conservation to maintain cerebral functioning is critical, where responses ascribed to the mammalian dive reflex, e.g. sympathetically mediated peripheral vasoconstriction and vagally mediated bradycardia, are central. In defence of maintaining global cerebral oxygen delivery during prolonged breath holds, the cerebral blood flow may increase by \u223c100% from resting values. Interestingly, near the termination of prolonged dry static breath holds, recent studies also indicate that reductions in the cerebral oxidative metabolism can occur, probably attributable to the extreme hypercapnia and irrespective of the hypoxaemia. In this review, we highlight and discuss the recent data on the cardiovascular, metabolic and, particularly, cerebrovascular function in competitive apneists performing maximal static breath holds. The physiological adaptation and maladaptation with regular breath\u2010hold training are also summarized, and future research areas in this unique physiological field are highlighted; particularly, the need to determine the potential long\u2010term health impacts of extreme breath holding.<\/jats:p><\/jats:sec>","DOI":"10.1113\/ep086269","type":"journal-article","created":{"date-parts":[[2018,3,7]],"date-time":"2018-03-07T07:52:42Z","timestamp":1520409162000},"page":"635-651","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":96,"title":["Physiology of static breath holding in elite apneists"],"prefix":"10.1113","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7910-6921","authenticated-orcid":false,"given":"Anthony R.","family":"Bain","sequence":"first","affiliation":[{"name":"Center for Heart, Lung and Vascular Health University of British Columbia Kelowna BC Canada"},{"name":"Integrative Physiology University 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