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Pharyngeal Motor Control And The Pathogenesis Of Obstructive Sleep Apnea
A. Jordan, D. White
Published 2008 · Medicine
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The upper airway in patients with obstructive sleep apnea (OSA) is thought to collapse during sleep at least in part, because of a sleep related reduction in upper airway dilator muscle activity. Therefore, a comprehensive understanding of the neural regulation of these muscles is warranted. The dilator muscles can be classified in two broad categories; those that have respiratory related activity and those that fire constantly throughout the respiratory cycle. The motor control of these two groups likely differs with the former receiving input from respiratory neurons and negative pressure reflex circuits. The activity of both muscle groups is reduced shortly after sleep onset, indicating that both receive input from brainstem neurons involved in sleep regulation. In the apnea patient, this may lead to pharyngeal airway collapse. This review briefly describes the currently proposed sleep and respiratory neural pathways and how these circuits interact with the upper airway dilator muscle motorneurones, including recent evidence from animal studies.
This paper references
The nature of the wakefulness stimulus for breathing.
J. Orem (1990)
RESPIRATION AND THE HUMAN UPPER AIRWAY
D. White (1999)
Association of sleep-disordered breathing and the occurrence of stroke.
M. Arzt (2005)
Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome.
L. Doherty (2005)
Influences of NREM sleep on the activity of tonic vs. inspiratory phasic muscles in normal men.
D. J. Tangel (1992)
Activity of respiratory pump and upper airway muscles during sleep onset.
C. Worsnop (1998)
Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model.
D. Brooks (1997)
Neuromechanical control of upper airway patency during sleep.
S. Patil (2007)
Upper airway muscles awake and asleep.
F. Sériès (2002)
Control of breathing in health and disease
M. Altose (1999)
Obstructive sleep apnea as a risk factor for stroke and death.
H. Yaggi (2005)
Inhibition of serotonergic medullary raphe obscurus neurons suppresses genioglossus and diaphragm activities in anesthetized but not conscious rats.
S. Sood (2006)
Neurobiology of the Sleep-Wake Cycle: Sleep Architecture, Circadian Regulation, and Regulatory Feedback
P. Fuller (2006)
Genioglossal inspiratory activation: central respiratory vs mechanoreceptive influences.
G. Pillar (2001)
Mechanisms used to restore ventilation after partial upper airway collapse during sleep in humans
A. Jordan (2007)
Central nervous system distribution of the transcription factor Phox2b in the adult rat
B. J. Kang (2007)
Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls.
R. Schwab (1995)
Postural effects on pharyngeal protective reflex mechanisms.
A. Malhotra (2004)
Motor control of the pharyngeal musculature and implications for the pathogenesis of obstructive sleep apnea.
R. Horner (1996)
The neuropharmacology of upper airway motor control in the awake and asleep states: implications for obstructive sleep apnoea
R. Horner (2001)
Prospective study of the association between sleep-disordered breathing and hypertension.
P. Peppard (2000)
Genioglossus premotoneurons and the negative pressure reflex in rats
N. Chamberlin (2007)
Invited review: Intermittent hypoxia and respiratory plasticity.
G. S. Mitchell (2001)
The occurrence of sleep-disordered breathing among middle-aged adults.
T. Young (1993)
Identification of rat brainstem multisynaptic connections to the oral motor nuclei using pseudorabies virus: I. Masticatory muscle motor systems
Richard A Fay (1997)
Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.
T. Young (1997)
Looking for inspiration: new perspectives on respiratory rhythm
J. Feldman (2006)
Recent advances in understanding the pathogenesis of obstructive sleep apnea
A. Jordan (2003)
Influence of wakefulness on pharyngeal airway muscle activity
Yu-Lun Lo (2007)
Airway mechanics and ventilation in response to resistive loading during sleep: influence of gender.
G. Pillar (2000)
Modeling hypersomnolence in sleep-disordered breathing. A novel approach using survival analysis.
N. Punjabi (1999)
Genioglossal but not palatal muscle activity relates closely to pharyngeal pressure.
A. Malhotra (2000)
Serotonergic effects on hypoglossal neural activity and reflex responses
M. A. Douse (1996)
Inspiratory coactivation of the genioglossus enlarges retroglossal space in laryngectomized humans.
I. Kobayashi (1996)
Upper airway muscle activation is augmented in patients with obstructive sleep apnea compared with that in normal subjects.
P. Suratt (1988)
Con: sleep apnea is not an anatomic disorder.
K. Strohl (2003)
Effect of posture and breathing route on genioglossal electromyogram activity in normal subjects and in patients with the sleep apnea/hypopnea syndrome.
N. Douglas (1993)
Mechanisms of Airway Hypotonia
L. Kubin (2002)
Respiratory-related activation and mechanical effects of the pharyngeal constrictor muscles.
S. Kuna (2000)
Endogenous excitatory drive modulating respiratory muscle activity across sleep-wake states.
E. Chan (2006)
Gender differences in airway resistance during sleep.
J. Trinder (1997)
Sleep-disordered breathing and neuropsychological deficits. A population-based study.
H. Kim (1997)
The effect of tensor veli palatini stimulation on upper airway patency.
A. McWhorter (1999)
The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea versus controls
R. Fogel (2005)
Principles and Practice of Sleep Medicine
M. Kryger (1989)
Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial
J. Pepperell (2002)
Changes in airway resistance during sleep onset.
A. Kay (1994)
Pro: sleep apnea is an anatomic disorder.
R. Schwab (2003)
Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea.
M. Younes (2003)
Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study
J. M. Marı́n (2005)
Breathing route influences upper airway muscle activity in awake normal adults.
R. Basner (1989)
Respiratory function of hyoid muscles and hyoid arch.
W. B. Van de Graaff (1984)
Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism).
W. Mezzanotte (1992)
Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls.
W. Mezzanotte (1996)
This paper is referenced by
The dual role of the orexin/hypocretin system in modulating wakefulness and respiratory drive
C. Gestreau (2008)
Sleep and respiratory physiology in adults.
Mudiaga O Sowho (2014)
Impacto da fase REM no índice de apneia-hipopneia
Sandra Pires (2015)
Role of Sensory Stimulation in Amelioration of Obstructive Sleep Apnea
Mak Adam Daulatzai (2011)
Dopaminergic Control of Trigeminal Motor Outflow to Upper Airway Muscles in Anaesthetized Rats
Peter B Schwarz (2009)
Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis
W. S. Jeong (2017)
Chapter 16 – Pathophysiology of Obstructive Sleep Apnea
Richard B. Berry (2012)
Anatomy and physiology of the upper airway in obstructive sleep apnea
Jennifer C. Hsia (2015)
Sleep-disordered breathing in patients with decompensated heart failure
M. Valdivia-Arenas (2008)
Orexinergic modulation of breathing across vigilance states
T. Kuwaki (2008)
Endothelial progenitor cells in cardiovascular disease and hypoxia--potential implications to obstructive sleep apnea.
S. Berger (2011)
Brain activation changes before and after PAP treatment in obstructive sleep apnea.
V. Castronovo (2009)
Polymorphisms of the 5-hydroxytryptamine 2A/2C receptor genes and 5-hydroxytryptamine transporter gene in Chinese patients with OSAHS
H. Chen (2013)
Intranasal mometasone furoate therapy for allergic rhinitis symptoms and rhinitis-disturbed sleep.
E. Meltzer (2010)
Upper airway collapsibility during wakefulness in children with sleep disordered breathing, as determined by the negative expiratory pressure technique.
H. L. Carrera (2011)
Effect of Maxillomandibular Advancement Surgery on Blood Pressure in Patients With Obstructive Sleep Apnea
R. Goodday (2012)
Acute intermittent hypoxia induces hypoglossal nerve metaplasticity in a 5-HT 2 A R-activated protein kinase C dependent manner in chronic intermittent hypoxia-pretreated rats
N. Wang (2016)
Addressing obstructive sleep apnea in the emergency department.
D. Vearrier (2011)
Fusion of the 1H NMR data of serum, urine and exhaled breath condensate in order to discriminate chronic obstructive pulmonary disease and obstructive sleep apnea syndrome
A. Ząbek (2015)
A Modified Cosmetic Genioplasty Can Affect Airway Space Positively in Skeletal Class II Patients: Studying Alterations of Hyoid Bone Position and Posterior Airway Space
K. Chen (2020)
Advanced Concepts in the Pathophysiology of Obstructive Sleep Apnea.
D. White (2017)
Role of respiratory control mechanisms in the pathogenesis of obstructive sleep disorders.
M. Younes (2008)
Sleep disordered breathing following spinal cord injury
F. Biering-Sørensen (2009)
Neural control of the upper airway: integrative physiological mechanisms and relevance for sleep disordered breathing.
R. Horner (2012)
Overnight rostral fluid shift in obstructive sleep apnea: does it affect the severity of sleep-disordered breathing?
B. Jafari (2011)
Obstructive Sleep Apnea in Adults: The Role of Upper Airway and Facial Skeletal Surgery
R. Garg (2016)
Orexin A activates hypoglossal motoneurons and enhances genioglossus muscle activity in rats
G. Zhang (2014)
Orexin neurons as arousal-associated modulators of central cardiorespiratory regulation
T. Kuwaki (2010)
A novel nasopharyngeal stent for the treatment of obstructive sleep apnea: a case series of nasopharyngeal stenting versus continuous positive airway pressure
M. Traxdorf (2015)
Diagnosis and Management of Obstructive Sleep Apnea: A Review.
Daniel J. Gottlieb (2020)
Avancée mandibulaire dans le syndrome d'apnées obstructives du sommeil : interactions avec l'orthopédie dento-faciale
J. Cohen-lévy (2012)
Soft tissue changes after maxillo-mandibular advancement in OSAS patients: a three-dimensional study.
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