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Arousal from sleep: implications for obstructive sleep apnea pathogenesis and treatment
Danny J Eckert1, Magdy K Younes
1Neuroscience Research Australia (NeuRA Randwick, New South Wales, Australia;
Journal of Applied Physiology (Bethesda, Md. : 1985)
|August 31, 2013
Summary
Cortical arousals, once thought to restore breathing in obstructive sleep apnea (OSA), may actually worsen it. This review explores how these awakenings impact OSA and potential treatments.
Area of Science:
- Sleep Medicine
- Respiratory Physiology
- Neuroscience
Background:
- Obstructive sleep apnea (OSA) is often treated by brief awakenings from sleep, known as cortical arousals, which are believed to restore airflow.
- However, recent research suggests that many OSA events do not end with cortical arousal.
- Furthermore, cortical arousals might paradoxically perpetuate breathing instability and airway closure in OSA.
Purpose of the Study:
- To review the mechanisms of respiratory-induced cortical arousal in OSA.
- To examine physiological factors influencing cortical arousal propensity.
- To discuss the dual role of cortical arousal in OSA pathogenesis and potential therapeutic implications of modulating arousal propensity.
Main Methods:
- Literature review of current understanding on cortical arousal in OSA.
- Summary of physiological factors influencing arousal.
- Discussion of therapeutic strategies targeting cortical arousal.
Main Results:
- Cortical arousals are not always the termination mechanism for OSA events.
- Cortical arousals can potentially worsen OSA by perpetuating instability and airway closure.
- Sedative agents may reduce cortical arousal propensity, offering potential therapeutic benefits for some OSA patients.
Conclusions:
- The role of cortical arousal in OSA is complex and potentially detrimental.
- Understanding arousal mechanisms is key to developing targeted OSA therapies.
- Modulating cortical arousal may be a viable treatment strategy for specific OSA patient populations.
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