Sleep apnea considered as a control system instability

Longobardo, Guy S.; Gothe, Barbara; Goldman, Michael; Cherniack, Neil S.

doi:10.1016/0034-5687(82)90026-3

Cited by 167 publications

(98 citation statements)

References 20 publications

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“…These models indicate that obstructive as well as central apnoeas can be due to control system instability. Central apnoeas increase the likelihood of obstructive apnoeas, whereas obstructive apnoeas tend to aggravate the control instability [68]. The interaction between central and obstructive apnoeas is, therefore, very likely and confirmed by many clinical observations.…”

Section: Control System Instabilitymentioning

confidence: 74%

“…Upper airway muscle activation due to increasing Pa,CO 2 may come behind the activation of the chest wall muscles. This represents an obvious cause of upper airway collapse [68]. During unstable breathing with waxing and waning of respiration, continuous changes in P a,CO 2 may trigger obstructive breaths by this particular type of mechanism.…”

Section: Interaction Between Central and Obstructive Sleep Apnoeamentioning

confidence: 99%

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Central sleep apnoea, pathogenesis and treatment: an overview and perspective

Backer

1995

Eur Respir J

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C Ce en nt tr ra al l s sl le ee ep p a ap pn no oe ea a, , p pa at th ho og ge en ne es si is s a an nd d t tr re ea at tm me en nt t: : a an n o ov ve er rv vi ie ew w a an nd d p pe er rs sp pe ec ct ti iv ve e There is accumulating evidence that central sleep apnoea should be considered as the end of a spectrum. Instability in the breathing pattern is the main underlying mechanism and is due to the interaction of many factors. Breathing during sleep is dependent on metabolic control and the activity of the respiratory muscles. Treatment strategies are remarkably few in number. Use of nasal ventilation and the inhalation of CO 2 are mainly of theoretical interest, since patients do not often tolerate these more invasive therapies. Drug treatment, especially with acetazolamide, is easier to perform. Stimulation of upper airway reflexes, by less invasive methods, seems to be promising for the near future.

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Section: Control System Instabilitymentioning

confidence: 74%

Section: Interaction Between Central and Obstructive Sleep Apnoeamentioning

confidence: 99%

Central sleep apnoea, pathogenesis and treatment: an overview and perspective

Backer

1995

Eur Respir J

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“…PB is also found in healthy adults (PHILLIps0N, 1978) and neonates (RIGATTO and BRANDY, 1972) in special circumstances. A common model for PB has generally been proposed among the investigators, i.e., that PB is induced by in-cooperative negative feedback system (CHERNIACK and LONGOBARDO, 1973;LONGOBARDO et al, 1982;CARLEY and SHANNON, 1988). A given change ("disturbance") is introduced to regular breathing, which provokes change in blood gas.…”

Section: Discussionmentioning

confidence: 99%

Periodic breathing at high altitude and ventilatory responses to O2 and CO2.

et al. 1989

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To determine the relationship between periodic breathing (PB) during sleep at high altitude and ventilatory chemosensitivities, we studied nine Japanese climbers who participated in the expedition to the Kunlun Mountains (7,167m) in China in 1986. At sea level, ventilatory response to hypoxia (HVR) by isocapnic progressive hypoxia test and to hypercapnia (HCVR) by Read's method were examined. At altitude 5,360 m, respiratory movements of the chest and abdominal wall, Saoz, ECG, and HR were monitored. Seven climbers manifested PB during sleep. There was a significant correlation between PB during sleep and HVR and HCVR (p <0.05). All the climbers showed severe desaturation during sleep. There was a significant negative correlation between degree of desaturation during sleep and HVR (p <0.05). A negative correlation was also detected between PB and the degree of desaturation during sleep. We concluded that ventilatory chemosensitivities play an important role in eliciting PB and that climbers with high HVR can maintain their arterial oxygenation during sleep, due to hyperventilation induced by PB, which is considered an advantageous adaptation for lowland sojourners.

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“…Activity of the upper airway muscles remains behind the RC muscles during the apnoea, but again begins to precede activity of the RC muscles when the upper airway opens. This could represent periodicity of the respiratory controller [139], with reduced damping and increased gain. During tests of upper airway collapsibility in sleeping subjects with OSA, there was no evidence of increased drive to upper airway dilator muscles during progressive asphyxia, despite an apparent increase in drive to the DIA [140].…”

Section: Relationship Of Upper Airway and Diaphragmatic Emg Activitymentioning

confidence: 99%

Pathophysiology of obstructive sleep apnoea

Deegan¹,

McNicholas²

1995

Eur Respir J

263

183

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Arousal plays an important role in the termination of each apnoea, but may also contribute to the development of further apnoea, because of a reduction in respiratory drive related to the hypocapnia which results from postapnoeic hyperventilation. A cyclical pattern of repetitive obstructive apnoeas may result.A better understanding of the integrated pathophysiology of OSA should help in the development of new therapeutic techniques.

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Sleep apnea considered as a control system instability

Cited by 167 publications

References 20 publications

Central sleep apnoea, pathogenesis and treatment: an overview and perspective

Central sleep apnoea, pathogenesis and treatment: an overview and perspective

Periodic breathing at high altitude and ventilatory responses to O2 and CO2.

Pathophysiology of obstructive sleep apnoea

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