help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Published ahead of print on August 11, 2005, doi:10.1164/rccm.200412-1631SO
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200412-1631SOv1
172/11/1363    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by White, D. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by White, D. P.
American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 1363-1370, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200412-1631SO

Pulmonary Perspective

Pathogenesis of Obstructive and Central Sleep Apnea

David P. White

Division of Sleep Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to David P. White, M.D., Brigham and Women's Hospital Division of Sleep Medicine, Sleep Research at BI, 75 Francis Street, Boston, MA 02115. E-mail dpwhite{at}rics.bwh.harvard.edu

ABSTRACT

Considerable progress has been made over the last several decades in our understanding of the pathophysiology of both central and obstructive sleep apnea. Central sleep apnea, in its various forms, is generally the product of an unstable ventilatory control system (high loop gain) with increased controller gain (high hypercapnic responsiveness) generally being the cause. High plant gain can contribute under certain circumstances (hypercapnic patients). On the other hand, obstructive sleep apnea can develop as the result of a variety of physiologic characteristics. The combinations of these may vary considerably between patients. Most obstructive apnea patients have an anatomically small upper airway with augmented pharyngeal dilator muscle activation maintaining airway patency awake, but not asleep. However, individual variability in several phenotypic characteristics may ultimately determine who develops apnea and how severe the apnea will be. These include: (1) upper airway anatomy, (2) the ability of upper airway dilator muscles to respond to rising intrapharyngeal negative pressure and increasing Co2 during sleep, (3) arousal threshold in response to respiratory stimulation, and (4) loop gain (ventilatory control instability). As a result, patients may respond to different therapeutic approaches based on the predominant abnormality leading to the sleep-disordered breathing.

Key Words: Apnea, sleep, pathogenesis • central sleep apnea • obstructive sleep apnea • upper airway




This article has been cited by other articles:


Home page
 J. Appl. Physiol.Home page
M. Younes
Role of respiratory control mechanisms in the pathogenesis of obstructive sleep disorders
J Appl Physiol, November 1, 2008; 105(5): 1389 - 1405.
[Abstract] [Full Text] [PDF]

Home page
 J. Physiol.Home page
M. McGuire, J. L. Tartar, Y. Cao, R. W. McCarley, D. P. White, R. E. Strecker, and L. Ling
Sleep fragmentation impairs ventilatory long-term facilitation via adenosine A1 receptors
J. Physiol., November 1, 2008; 586(21): 5215 - 5229.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al.
Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
Circulation, September 2, 2008; 118(10): 1080 - 1111.
[Full Text] [PDF]

Home page
 J Am Board Fam MedHome page
F. B. Willis, A. L. Isley, Y. E. Geda, L. Quarles IV, and P. A. Fredrickson
Resolution of Syncope With Treatment of Sleep Apnea
J Am Board Fam Med, September 1, 2008; 21(5): 466 - 468.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
E. N. Simantirakis, S. E. Schiza, N. S. Siafakas, and P. E. Vardas
Sleep-disordered breathing in heart failure and the effect of cardiac resynchronization therapy
Europace, September 1, 2008; 10(9): 1029 - 1033.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al.
Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
J. Am. Coll. Cardiol., August 19, 2008; 52(8): 686 - 717.
[Full Text] [PDF]

Home page
 CirculationHome page
H. A. Chami, R. B. Devereux, J. S. Gottdiener, R. Mehra, M. J. Roman, E. J. Benjamin, and D. J. Gottlieb
Left Ventricular Morphology and Systolic Function in Sleep-Disordered Breathing: The Sleep Heart Health Study
Circulation, May 20, 2008; 117(20): 2599 - 2607.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
D. J. Eckert, R. D. McEvoy, K. E. George, K. J. Thomson, and P. G. Catcheside
Effects of hypoxia on genioglossus and scalene reflex responses to brief pulses of negative upper-airway pressure during wakefulness and sleep in healthy men
J Appl Physiol, May 1, 2008; 104(5): 1426 - 1435.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
R. F. Fregosi
Influence of tongue muscle contraction and dynamic airway pressure on velopharyngeal volume in the rat
J Appl Physiol, March 1, 2008; 104(3): 682 - 693.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
D. J. Eckert and A. Malhotra
Pathophysiology of Adult Obstructive Sleep Apnea
Proceedings of the ATS, February 15, 2008; 5(2): 144 - 153.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. D. Bradley
Respiratory Sleep Medicine: A Coming of Age
Am. J. Respir. Crit. Care Med., February 15, 2008; 177(4): 363 - 364.
[Full Text] [PDF]

Home page
 Exp PhysiolHome page
G. S. Longobardo, C. J. Evangelisti, and N. S. Cherniack
Analysis of the interplay between neurochemical control of respiration and upper airway mechanics producing upper airway obstruction during sleep in humans
Exp Physiol, February 1, 2008; 93(2): 271 - 287.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
N. S. Cherniack
If I die before I wake: not a worry for sleep apnea patients
J Appl Physiol, December 1, 2007; 103(6): 1919 - 1920.
[Full Text] [PDF]

Home page
 ChestHome page
S. P. Patil, H. Schneider, A. R. Schwartz, and P. L. Smith
Adult Obstructive Sleep Apnea: Pathophysiology and Diagnosis
Chest, July 1, 2007; 132(1): 325 - 337.
[Abstract] [Full Text] [PDF]

Home page
 J. Physiol.Home page
D. J. Eckert, R. D. McEvoy, K. E. George, K. J. Thomson, and P. G. Catcheside
Genioglossus reflex inhibition to upper-airway negative-pressure stimuli during wakefulness and sleep in healthy males
J. Physiol., June 15, 2007; 581(3): 1193 - 1205.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
R. C. Basner
Continuous Positive Airway Pressure for Obstructive Sleep Apnea
N. Engl. J. Med., April 26, 2007; 356(17): 1751 - 1758.
[Full Text] [PDF]

Home page
 ChestHome page
S. Itzhaki, H. Dorchin, G. Clark, L. Lavie, P. Lavie, and G. Pillar
The Effects of 1-Year Treatment With a Herbst Mandibular Advancement Splint on Obstructive Sleep Apnea, Oxidative Stress, and Endothelial Function
Chest, March 1, 2007; 131(3): 740 - 749.
[Abstract] [Full Text] [PDF]

Home page
 J. Physiol.Home page
N. L. Chamberlin, M. Eikermann, P. Fassbender, D. P. White, and A. Malhotra
Genioglossus premotoneurons and the negative pressure reflex in rats
J. Physiol., March 1, 2007; 579(2): 515 - 526.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
D. J. Eckert, A. S. Jordan, P. Merchia, and A. Malhotra
Central Sleep Apnea: Pathophysiology and Treatment
Chest, February 1, 2007; 131(2): 595 - 607.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
J. P. Saboisky, R. B. Gorman, A. De Troyer, S. C. Gandevia, and J. E. Butler
Differential activation among five human inspiratory motoneuron pools during tidal breathing
J Appl Physiol, February 1, 2007; 102(2): 772 - 780.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. Eikermann, F. M. Vogt, F. Herbstreit, M. Vahid-Dastgerdi, M. O. Zenge, C. Ochterbeck, A. de Greiff, and J. Peters
The Predisposition to Inspiratory Upper Airway Collapse during Partial Neuromuscular Blockade
Am. J. Respir. Crit. Care Med., January 1, 2007; 175(1): 9 - 15.
[Abstract] [Full Text] [PDF]

Home page
 Exp PhysiolHome page
G. E. Foster, M. J. Poulin, and P. J. Hanly
Sleep Apnoea & Hypertension: Physiological bases for a causal relation: Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea
Exp Physiol, January 1, 2007; 92(1): 51 - 65.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
R. L. Horner and T. D. Bradley
Update in sleep and control of ventilation 2005.
Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 827 - 832.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2005 American Thoracic Society 		  2009/2010 ATS Fellows Career Development Awards