Central sympathetic nervous system reinforcement in obstructive sleep apnoea

Area of Science:

• Neuroscience
• Cardiovascular Physiology
• Sleep Medicine

Background:

• Conflicting results exist regarding cerebrovascular reactivity and cerebral oxygenation in obstructive sleep apnea (OSA).
• Evidence suggests diminished resting-state cerebral perfusion in OSA patients.
• Healthy breath-hold divers exhibit stable cerebral oxygenation during apnea via sympathetic nervous system (SNS) activation, contrasting OSA findings.

Purpose of the Study:

• To review and explain discrepancies in cerebral oxygenation and perfusion findings in OSA.
• To explore mechanisms of central SNS reinforcement in OSA.
• To propose novel insights into cerebral blood flow regulation and its alteration in OSA.

Main Methods:

• Review of existing literature on OSA, cerebrovascular reactivity, cerebral oxygenation, and SNS.
• In-depth analysis of central SNS reinforcement mechanisms in OSA.
• Discussion of physiological factors influencing cerebral blood flow regulation.

Main Results:

• Dysfunctional baroreflex response and neuroinflammation are key SNS reinforcement mechanisms in OSA.
• Short-term blood pressure changes, heart rate fluctuations, and baroreflex alterations impact cerebral blood flow.
• Increased blood flow pulsatility may affect cerebrospinal fluid circulation and SNS drive.

Conclusions:

• Sympathetic nervous system reinforcement in OSA promotes maladaptive mechanisms.
• Altered cerebral perfusion regulation can lead to functional and structural brain changes in OSA.
• Understanding these mechanisms is crucial for managing OSA-related neurological complications.