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Clinical neurophysiology of apnea.
Handb Clin Neurol 2019; 161:345-352HC

Abstract

Understanding the clinical neurophysiology of apnea generation encompasses discussion of the neuroanatomic aspects of central respiratory rhythm and pattern generation, including the central respiratory control networks, central and peripheral chemoreceptors, mechanisms of respiratory muscles, and sleep state dependent differences. Anatomical and functional links to apnea also involve central respiratory motor output recruited from the hypoglossal nerve, which has led to novel treatments for obstructive sleep apnea. Autonomic fluctuations occur in relation to sleep-wake and sleep states (i.e., REM vs NREM sleep), with both parasympathetic and sympathetic contributions. Finally, our understanding of the pathophysiology of obstructive sleep apnea now includes concepts of critical closing pressure of the upper airway, increased loop gain as reflected by high responsiveness to external perturbations, inadequate responsiveness of upper airway muscle recruitment, and reductions in arousal threshold leading to ventilatory instability. In turn, these concepts have led to the development of novel therapies such as hypoglossal nerve stimulation and targeting key culprit physiologic mechanisms specific to the individual.

Authors+Show Affiliations

Sleep Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.Sleep Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States. Electronic address: mehrar@ccf.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31307612

Citation

Waters, Tina, and Reena Mehra. "Clinical Neurophysiology of Apnea." Handbook of Clinical Neurology, vol. 161, 2019, pp. 345-352.
Waters T, Mehra R. Clinical neurophysiology of apnea. Handb Clin Neurol. 2019;161:345-352.
Waters, T., & Mehra, R. (2019). Clinical neurophysiology of apnea. Handbook of Clinical Neurology, 161, pp. 345-352. doi:10.1016/B978-0-444-64142-7.00059-X.
Waters T, Mehra R. Clinical Neurophysiology of Apnea. Handb Clin Neurol. 2019;161:345-352. PubMed PMID: 31307612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical neurophysiology of apnea. AU - Waters,Tina, AU - Mehra,Reena, PY - 2019/7/17/entrez KW - Arousal threshold KW - Autonomic function KW - Critical closing airway pressure KW - Hypoglossal nerve KW - Loop gain KW - Neuroanatomy KW - Obstructive sleep apnea KW - Pathophysiology SP - 345 EP - 352 JF - Handbook of clinical neurology JO - Handb Clin Neurol VL - 161 N2 - Understanding the clinical neurophysiology of apnea generation encompasses discussion of the neuroanatomic aspects of central respiratory rhythm and pattern generation, including the central respiratory control networks, central and peripheral chemoreceptors, mechanisms of respiratory muscles, and sleep state dependent differences. Anatomical and functional links to apnea also involve central respiratory motor output recruited from the hypoglossal nerve, which has led to novel treatments for obstructive sleep apnea. Autonomic fluctuations occur in relation to sleep-wake and sleep states (i.e., REM vs NREM sleep), with both parasympathetic and sympathetic contributions. Finally, our understanding of the pathophysiology of obstructive sleep apnea now includes concepts of critical closing pressure of the upper airway, increased loop gain as reflected by high responsiveness to external perturbations, inadequate responsiveness of upper airway muscle recruitment, and reductions in arousal threshold leading to ventilatory instability. In turn, these concepts have led to the development of novel therapies such as hypoglossal nerve stimulation and targeting key culprit physiologic mechanisms specific to the individual. SN - 0072-9752 UR - https://www.unboundmedicine.com/medline/citation/31307612/Clinical_neurophysiology_of_apnea L2 - https://linkinghub.elsevier.com/retrieve/pii/B978-0-444-64142-7.00059-X DB - PRIME DP - Unbound Medicine ER -