Functional Role of Neural Injury in Obstructive Sleep Apnea

Saboisky, Julian P.; Butler, Jane E.; Gandevia, Simon C.; Eckert, Danny J.

doi:10.3389/fneur.2012.00095

Cited by 75 publications

(55 citation statements)

References 94 publications

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“…it is in fact known that stroke can worsen breathing by a number of mechanisms, such as inducing swallowing abnormalities, narrowing of oro-and/or hypo pharynx, or hypomobility of ribcage. [24][25][26][27][28][29][30][31] Furthermore, individuals with severe oSah have higher loop-gain than those with milder oSah, 32,33 therefore their breathing during sleep can shift from oSah to cSah.…”

Section: Resultsmentioning

confidence: 99%

Sleep Disordered Breathings in Patients with Stabilised Stroke – A Case Control Study

Minni¹,

Toni²,

Caramia³

et al. 2012

European Neurological Review

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Aim of the study: in order to characterise sleep disordered breathing (SdB) in patients with stable stroke, a prospective observational study is ongoing in Rome. We report the results of the first 55 cases studied. Methods: a consecutive series of patients with acute stroke, admitted to the stroke unit of two different Roman university hospitals, were screened. Participants were submitted to both clinical and instrumental evaluations at stroke onset and then at 4 months. The diagnostic tests included polisomnographyc (PSG) study and brain MRi. SdB, either central or obstructive, was diagnosed in presence of an apnoea/hypopnoea index (ahi) value ≥5. Statistical analysis was performed with SPSS version 18.0 for Windows. comparisons were done by χ2 tests or via Fisher's exact test depending on which was more appropriate. correlations were done with non-parametric tests (Spearman's rho). Statistical significance was set at p<0.05. Results: Fifty-five PSG studies were performed. Forty-two cases (76.4 %) had a SdB. Twenty-eight out of the 42 (67 %) cases with an ahi ≥5 had an obstructive sleep apnoea-hypopnoea (oSah) and 12 (29 %) cases had a central sleep apnoea-hypopnoea (cSah). Patients affected by cSah were significantly older than those affected by oSah (p=0.052). in the group of patients affected by predominantly oSah, the longer the time interval from stroke to PSG, the shorter both the total sleep period and the total sleep time. Patients with predominantly cSah were more frequently arrhythmic and more frequently affected by increase in pharyngeal tissue and referred significantly more frequently inattention or unrefreshing sleep. Discussion and Conclusions: The hypothesis we postulate is that, in a subgroup of patients with stroke, stroke moves to worsen patients' pre-existing breathing condition, causing ventilatory instability. in these cases, central apnoea may take precedence over the obstructive one, in a loop gain circuit over than one, that gives rise to alternating obstructive and central events (possible complex-sleep apnoeas). Multicentre studies, capable of enrolling larger cohorts, are needed to confirm this hypothesis. KeywordsStroke, sleep disordered breathing, complex sleep apnoea in order to characterise SdB in patients with stable stroke, a prospective observational study is ongoing in Rome. We report the results of the first 55 cases studied.

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Section: Resultsmentioning

confidence: 99%

Sleep Disordered Breathings in Patients with Stabilised Stroke – A Case Control Study

Minni¹,

Toni²,

Caramia³

et al. 2012

European Neurological Review

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“…Thus, there is a large body of evidence that UA neuromuscular abnormalities are frequent in OSAS patients, and these altogether support the neurogenic theory of OSAS [5][6][7]34]. In recent years, multiple studies have demonstrated altered UA sensory input and abnormal UA motor function in patients with OSAS using a variety of neurophysiological and histological approaches [5,7,[35][36][37], and impaired neural function is at least partly reversible with treatment for sleep apnea [27].…”

Section: The Neurological Theory Of Osas and The Upper Airways Remodementioning

confidence: 98%

“…Changes in sensation, muscle structure, and physiological properties of UA have been reported in patients with OSAS; these changes are referred to as airway remodeling. But whereas the structural and functional properties of muscles of OSAS patients have been extensively analyzed [5,[12][13][14], the motor nerve fibers and motor endplates as well as the potential role of sensory nerve impairment in OSAS have not been sufficiently investigated [15,16]. Furthermore, the available data are heterogeneous and sometimes contradictory, because of the heterogeneity of the UA muscles, the different nerves innervating these muscles and the UA mucosae, and the differences in the methods used.…”

Section: The Neurological Theory Of Osas and The Upper Airways Remodementioning

confidence: 99%

“…In recent years, multiple studies have demonstrated altered UA sensory input and abnormal UA motor function in patients with OSAS using a variety of neurophysiological and histological approaches [5,7,[35][36][37], and impaired neural function is at least partly reversible with treatment for sleep apnea [27].…”

Section: The Neurological Theory Of Osas and The Upper Airways Remodementioning

confidence: 99%

“…Two primary theories have been proposed to explain the pathophysiology of OSAS: the obstructive theory, in which muscle hypertrophy leads to airway narrowing, and the neurogenic theory, which postulates that peripheral nerve degeneration due to vibratory stretch trauma, or systemic diseases, lead to muscle atrophy and collapse [5][6][7]. A progressive local neurogenic lesion caused by repeated microtrauma of snoring might be a potential contribution factor for UA collapsibility [8].…”

Section: Introductionmentioning

confidence: 99%

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Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Cobo¹,

Macías²,

Alvarez³

et al. 2017

Sleep Apnea - Recent Updates

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Obstructive sleep apnea syndrome (OSAS) is a widely diffused disease associated with specific genetics, age, gender, craniofacial and upper airways anatomy, obesity, and endocrine conditions, but not with ethnicity profiles. The so-called neurogenic neurogenic theory of OSAS postulates that the collapse of the upper airways that characterize this disease is due to peripheral nerve degeneration that leads to muscle atrophy and collapse. This review attempts to summarize the structural and functional changes in both the sensory and motor innervation of the walls of the upper air ways in patients suffering from OSAS.

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Sensory Innervation of the Human Soft Palate

Chen

et al. 2018

The Anatomical Record

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The human soft palate plays an important role in respiration, swallowing, and speech. These motor activities depend on reflexes mediated by sensory nerve endings. To date, the details of human sensory innervation to the soft palate have not been demonstrated. In this study, eight adult human whole-mount (soft palate-tongue-pharynx-larynx-upper esophagus) specimens were obtained from autopsy. Each specimen was bisected in the midline, forming two equal and symmetrical halves. Eight hemi-specimens were processed with Sihler's stain, a whole-mount nerve staining technique. The remaining eight hemi-soft palates were used for immunohistochemical study. The soft palatal mucosa was dissected from the oral and nasal sides and prepared for neurofilament staining. Our results showed that the sensory nerve fibers formed a dense nerve plexus in the lamina propria of the soft palatal mucosa. There was a significant difference in the innervation density between both sides. Specifically, the oral side had higher density of sensory nerve fibers than the nasal side of the soft palate. The mean number and percent area of the sensory nerve fibers in the mucosa of the nasal side was 78% and 72% of those in the mucosa of the oral side, respectively (P < 0.0001). The data presented here could be helpful for further investigating the morphological and quantitative alterations in the sensory nerves in certain upper airway disorders involving the soft palate such as obstructive sleep apnea (OSA) and for designing effective therapeutic strategies to treat OSA. Anat Rec, 301:1861-1870, 2018. © 2018 Wiley Periodicals, Inc.

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Functional Role of Neural Injury in Obstructive Sleep Apnea

Cited by 75 publications

References 94 publications

Sleep Disordered Breathings in Patients with Stabilised Stroke – A Case Control Study

Sleep Disordered Breathings in Patients with Stabilised Stroke – A Case Control Study

Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Sensory Innervation of the Human Soft Palate

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