Mechanisms of Apnea

Eckert, Danny J.; Malhotra, Atul; Jordan, Amy S.

doi:10.1016/j.pcad.2008.02.003

Cited by 154 publications

(123 citation statements)

References 91 publications

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“…This finding has also been reported in studies of repetitive respiratory events in adults with OSA (29). It has been hypothesized that at the transition from wake to sleep, several respiratory control mechanisms are down regulated, upper airway dilator and respiratory pump muscle tone is reduced, and there is a reduction in chemosensitivity leading to respiratory instability (29,30). Furthermore, hypopneas can be induced when the transition to sleep occurs rapidly and there is a delay in the compensatory response from the chemoreceptors (31).…”

Section: Repetitive Respiratory Events In Childrensupporting

confidence: 87%

“…The majority of episodes occurred during N1 stage sleep. This finding has also been reported in studies of repetitive respiratory events in adults with OSA (29). It has been hypothesized that at the transition from wake to sleep, several respiratory control mechanisms are down regulated, upper airway dilator and respiratory pump muscle tone is reduced, and there is a reduction in chemosensitivity leading to respiratory instability (29,30).…”

Section: Repetitive Respiratory Events In Childrensupporting

confidence: 72%

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Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

et al. 2015

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Data presented as mean ± SEM or median (range). *P < 0.05; † P < 0.001. HR, heart rate; PTT, pulse transit time. Articles Walter et al. Cardiovascular Consequences of Repetitive vs. Isolated Respiratory EventsFor the episodes of repetitive events, the % change in HR from late to between events and from late event to postepisode were significantly higher when compared with the % change in HR from late to postevent in isolated respiratory events (P < 0.001 for both), as shown in Figure 2a. The % change in PTT from late event to postepisode was significantly greater (indicating a greater change in BP) for repetitive episodes when compared with the % change from late to postevents in isolated respiratory events (P < 0.05) (Figure 2b). There was no difference between % change in PTT from late to between events in repetitive episodes compared with % change from late to postevents in isolated respiratory events. The ratio of repetitive to isolated respiratory events for each child significantly predicted the mean HR, which increased with an increasing proportion of repetitive respiratory events compared with isolated events during N1, N2, REM, and total sleep (Figure 3). There were no relationships between mean PTT and the ratio of repetitive to isolated respiratory events during wake or any sleep stage. Determinants of Percentage Change in HR and PTT From Lateto Between-Event Phases in Episodes of Repetitive Respiratory EventsResults of the multiple linear regression analysis indicate that during total sleep, the repetitive to isolated events ratio, the number of individual respiratory events per episode, the number of arousals per episode, the ratio of the duration of the respiratory event to the duration of the subsequent between event period, and sleep stage were significantly, if weakly predictive of the % change in HR from the late event phase to between the respiratory events ( Table 3). The model predicted 44% of the % change in HR from the late event phase to between the respiratory events (P < 0.01). This suggests that the more repetitive events compared with isolated events, the more episodes, the more events and arousals per episode a child has, the higher the surge in HR. In contrast, there is a negative relationship between the surge in HR and sleep stage, suggesting that the HR surge is highest during N1 and decreases during N2, N3, and REM. There is also a weak negative relationship between the surge in HR and the ratio of the duration of an event to the duration of the between event period, suggesting that the closer together the events become the % change in HR is not as great.Further analyses separating the repetitive respiratory event episodes into the sleep stage in which they occurred demonstrated that when the episodes occurred during N1 sleep, the predictive variables remained the same as for total sleep. When the episodes occurred during N2 or REM sleep, only the number of arousals in the episode predicted the change in HR (r 2 = 0.3, P < 0.01; REM: r 2 = 0.5, P < 0.001). None of the variables ...

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Section: Repetitive Respiratory Events In Childrensupporting

confidence: 87%

Section: Repetitive Respiratory Events In Childrensupporting

confidence: 72%

Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

et al. 2015

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“…in those cases it has been postulated that an increase in carbon dioxide sensitivity can destabilise breathing during sleep, giving rise to recurrent cycles of central apnoea and hyperventilation during sleep. [35][36][37][38][39][40][41][42] This study has several limitations, the most important being the small sample size of mild stroke cases, who were not submitted to neither oRl evaluation nor a sleep study before stroke. Since no relationship was found in this study between the site of brain injury and SdB, we are not able to evaluate its possible role on SdB.…”

Section: Discussionmentioning

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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“…5,6,8 In FD patients, anatomical anomalies and peripheral neuropathic factors could facilitate partial or complete airway closure already at a pharyngeal critical closing pressure which is higher than in healthy persons. 36 Mass el al. described craniofacial anomalies in FD patients, with retrognathic position of the maxilla and particularly the mandibular, reclination of the lower incisors, and small jaws, which frequently cause difficulties in airway management during sedation or anesthesia.…”

Section: Obstructive Apneas Were More Common Than Central Apneas In Omentioning

confidence: 99%

Obstructive Sleep-Disordered Breathing Is More Common than Central in Mild Familial Dysautonomia

Hilz

Moeller

Buechner

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives:In familial dysautonomia (FD) patients, sleep-disordered breathing (SDB) might contribute to their high risk of sleep-related sudden death. Prevalence of central versus obstructive sleep apneas is controversial but may be therapeutically relevant. We, therefore, assessed sleep structure and SDB in FD-patients with no history of SDB. Methods: 11 mildly affected FD-patients (28 ± 11 years) without clinically overt SDB and 13 controls (28 ± 10 years) underwent polysomnographic recording during one night. We assessed sleep stages, obstructive and central apneas (≥ 90% air flow reduction) and hypopneas (> 30% decrease in airflow with ≥ 4% oxygen-desaturation), and determined obstructive (oAI) and central (cAI) apnea indices and the hypopnea index (HI) as count of respective apneas/hypopneas divided by sleep time. We obtained the apnea-hypopnea index (AHI4%) from the total of apneas and hypopneas divided by sleep time. We determined differences between FD-patients and controls using the U-test and within-group differences between oAIs, cAIs, and HIs using the Friedman test and Wilcoxon test. Results: Sleep structure was similar in FD-patients and controls. AHI4% and HI were significantly higher in patients than controls. In patients, HIs were higher than oAIs and oAIs were higher than cAIs. In controls, there was no difference between HIs, oAIs, and cAIs. Only patients had apneas and hypopneas during slow wave sleep. Conclusions: In our FD-patients, obstructive apneas were more common than central apneas. These findings may be related to FD-specific pathophysiology. The potential ramifications of SDB in FD-patients suggest the utility of polysomnography to unveil SDB and initiate treatment. Commentary: A commentary on this article appears in this issue on page 1583. Keywords: familial dysautonomia, hereditary sensory and autonomic neuropathy type III, obstructive sleep apnea, sleep-disordered breathing Citation: Hilz MJ, Moeller S, Buechner S, Czarkowska H, Ayappa I, Axelrod FB, Rapoport DM. Obstructive sleep-disordered breathing is more common than central in mild familial dysautonomia.

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Mechanisms of Apnea

Cited by 154 publications

References 91 publications

Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

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

Obstructive Sleep-Disordered Breathing Is More Common than Central in Mild Familial Dysautonomia

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