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Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome.
Sleep. 2015 Nov 01; 38(11):1743-9.S

Abstract

STUDY OBJECTIVES

The obstructive sleep apnea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered, imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Experimental inspiratory loading in normal subjects elicits respiratory-related cortical activity. The objective of this study was to test whether awake OSAS patients would exhibit a similar cortical activity.

DESIGN

Descriptive physiology study.

SETTING

Sleep laboratory in a large university affiliated tertiary hospital.

PATIENTS

26 patients with moderate OSAS according to polysomnography (5 < apnea-hypopnea index [AHI] ≤ 30, n = 14) or severe OSAS (AHI > 30, n = 12); 13 non-OSAS patients for comparison.

INTERVENTIONS

None.

MEASUREMENTS

Respiratory time-locked electroencephalographic segments ensemble averaged and analyzed for slow premotor potentials preceding inspiration ("pre-inspiratory potentials" [PIPs]).

RESULTS

PIPs were present in 1/13 controls and 11/26 patients (P = 0.0336; 4/14 "moderate" and 7/12 "severe" patients). Awake OSAS patients therefore exhibit respiratory-related cortical activity during quiet breathing significantly more frequently than non-OSAS individuals. The corresponding PIPs resemble those observed during prepared voluntary inspirations and in response to experimental inspiratory loads in normal subjects, which involve a cortical network comprising the supplementary motor area.

CONCLUSIONS

A respiratory-related cortical activity could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in obstructive sleep apnea, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. Whether or not such cortical compensatory mechanisms have cognitive consequences remains to be determined.

Links

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Authors+Show Affiliations

Launois C
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.
Attali V
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.
Georges M
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.
Raux M
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Surveillance Post-Interventionnelle et d'Accueil des Polytraumatisés (Département d'Anesthésie Réanimation), Paris, France.
Morawiec E
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
Rivals I
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. Ecole Supérieure de Physique et de Chimie de la Ville de Paris, Paris, France.
Arnulf I
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.
Similowski T
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.

MeSH

AdultAgedArousalCase-Control StudiesCerebral CortexDriveElectroencephalographyFemaleHumansMaleMiddle AgedPolysomnographyRespirationRespiratory SystemSleepSleep Apnea, ObstructiveWakefulness

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26158887

Citation

Launois, Claire, et al. "Cortical Drive to Breathe During Wakefulness in Patients With Obstructive Sleep Apnea Syndrome." Sleep, vol. 38, no. 11, 2015, pp. 1743-9.
Launois C, Attali V, Georges M, et al. Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome. Sleep. 2015;38(11):1743-9.
Launois, C., Attali, V., Georges, M., Raux, M., Morawiec, E., Rivals, I., Arnulf, I., & Similowski, T. (2015). Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome. Sleep, 38(11), 1743-9. https://doi.org/10.5665/sleep.5156
Launois C, et al. Cortical Drive to Breathe During Wakefulness in Patients With Obstructive Sleep Apnea Syndrome. Sleep. 2015 Nov 1;38(11):1743-9. PubMed PMID: 26158887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome. AU - Launois,Claire, AU - Attali,Valérie, AU - Georges,Marjolaine, AU - Raux,Mathieu, AU - Morawiec,Elise, AU - Rivals,Isabelle, AU - Arnulf,Isabelle, AU - Similowski,Thomas, Y1 - 2015/11/01/ PY - 2015/01/06/received PY - 2015/05/22/accepted PY - 2015/7/10/entrez PY - 2015/7/15/pubmed PY - 2016/5/6/medline KW - cerebral cortex KW - control of breathing KW - pre-inspiratory potentials KW - sleep apnea syndrome SP - 1743 EP - 9 JF - Sleep JO - Sleep VL - 38 IS - 11 N2 - STUDY OBJECTIVES: The obstructive sleep apnea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered, imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Experimental inspiratory loading in normal subjects elicits respiratory-related cortical activity. The objective of this study was to test whether awake OSAS patients would exhibit a similar cortical activity. DESIGN: Descriptive physiology study. SETTING: Sleep laboratory in a large university affiliated tertiary hospital. PATIENTS: 26 patients with moderate OSAS according to polysomnography (5 < apnea-hypopnea index [AHI] ≤ 30, n = 14) or severe OSAS (AHI > 30, n = 12); 13 non-OSAS patients for comparison. INTERVENTIONS: None. MEASUREMENTS: Respiratory time-locked electroencephalographic segments ensemble averaged and analyzed for slow premotor potentials preceding inspiration ("pre-inspiratory potentials" [PIPs]). RESULTS: PIPs were present in 1/13 controls and 11/26 patients (P = 0.0336; 4/14 "moderate" and 7/12 "severe" patients). Awake OSAS patients therefore exhibit respiratory-related cortical activity during quiet breathing significantly more frequently than non-OSAS individuals. The corresponding PIPs resemble those observed during prepared voluntary inspirations and in response to experimental inspiratory loads in normal subjects, which involve a cortical network comprising the supplementary motor area. CONCLUSIONS: A respiratory-related cortical activity could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in obstructive sleep apnea, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. Whether or not such cortical compensatory mechanisms have cognitive consequences remains to be determined. SN - 1550-9109 UR - https://www.unboundmedicine.com/medline/citation/26158887/Cortical_Drive_to_Breathe_during_Wakefulness_in_Patients_with_Obstructive_Sleep_Apnea_Syndrome_ DB - PRIME DP - Unbound Medicine ER -