Is there a threshold that triggers cortical arousals in obstructive sleep apnea

Yanru Li, Jeremy Orr, Rachel Jen, Scott A. Sands, Pamela DeYoung, Erik Smales, Bradley Edwards, Robert L. Owens, Atul Malhotra

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Study Objectives: To determine whether there is a consistent epiglottic pressure value that predicts respiratory arousal from sleep. Methods: Thirty-one patients with obstructive sleep apnea underwent overnight polysomnography while instrumented with an epiglottic catheter to measure airway pressures. Nadir epiglottic pressures during respiration events (obstructive apneas/hypopneas) terminated with or without arousals were compared. The events were selected by two methods, (1) 20 events with/without arousals were randomly selected, and (2) Events were sampled in pairs (one terminated with arousal and one without arousal) to minimize the effect of sleep duration/stage on the measurement. Results: A total of 1,317 respiratory events were analyzed. There was substantial variability in nadir epiglottic pressure within an individual and among different individuals. The average pressure of 20 randomly selected events with arousals was (-21.2 ± 11.2, ranged -6.68 to -63.34 cm H2O). The nadir epiglottic pressure during respiratory events in NREM stage 2 sleep terminated with arousals was more negative compared with those terminated without arousals using both sampling methods (-23.5 vs. -18.5 cm H2O, p = 0.007 and -20.3 vs. -16.3 cm H2O, p < 0.001). Conclusions: There were very different levels of epiglottic pressures that preceded arousals within and among individuals. However, cortical arousals are associated with a level of more negative epiglottic pressure compared to events terminated without arousal, findings which support the concept of a respiratory arousal threshold.

Original languageEnglish
Article numberzsz047
Number of pages8
JournalSleep
Volume42
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • Arousal
  • Epiglottic pressure
  • Obstructive sleep apnea
  • Respiratory arousal threshold

Cite this

Li, Y., Orr, J., Jen, R., Sands, S. A., DeYoung, P., Smales, E., ... Malhotra, A. (2019). Is there a threshold that triggers cortical arousals in obstructive sleep apnea. Sleep, 42(6), [zsz047]. https://doi.org/10.1093/sleep/zsz047
Li, Yanru ; Orr, Jeremy ; Jen, Rachel ; Sands, Scott A. ; DeYoung, Pamela ; Smales, Erik ; Edwards, Bradley ; Owens, Robert L. ; Malhotra, Atul. / Is there a threshold that triggers cortical arousals in obstructive sleep apnea. In: Sleep. 2019 ; Vol. 42, No. 6.
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abstract = "Study Objectives: To determine whether there is a consistent epiglottic pressure value that predicts respiratory arousal from sleep. Methods: Thirty-one patients with obstructive sleep apnea underwent overnight polysomnography while instrumented with an epiglottic catheter to measure airway pressures. Nadir epiglottic pressures during respiration events (obstructive apneas/hypopneas) terminated with or without arousals were compared. The events were selected by two methods, (1) 20 events with/without arousals were randomly selected, and (2) Events were sampled in pairs (one terminated with arousal and one without arousal) to minimize the effect of sleep duration/stage on the measurement. Results: A total of 1,317 respiratory events were analyzed. There was substantial variability in nadir epiglottic pressure within an individual and among different individuals. The average pressure of 20 randomly selected events with arousals was (-21.2 ± 11.2, ranged -6.68 to -63.34 cm H2O). The nadir epiglottic pressure during respiratory events in NREM stage 2 sleep terminated with arousals was more negative compared with those terminated without arousals using both sampling methods (-23.5 vs. -18.5 cm H2O, p = 0.007 and -20.3 vs. -16.3 cm H2O, p < 0.001). Conclusions: There were very different levels of epiglottic pressures that preceded arousals within and among individuals. However, cortical arousals are associated with a level of more negative epiglottic pressure compared to events terminated without arousal, findings which support the concept of a respiratory arousal threshold.",
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Li, Y, Orr, J, Jen, R, Sands, SA, DeYoung, P, Smales, E, Edwards, B, Owens, RL & Malhotra, A 2019, 'Is there a threshold that triggers cortical arousals in obstructive sleep apnea', Sleep, vol. 42, no. 6, zsz047. https://doi.org/10.1093/sleep/zsz047

Is there a threshold that triggers cortical arousals in obstructive sleep apnea. / Li, Yanru; Orr, Jeremy; Jen, Rachel; Sands, Scott A.; DeYoung, Pamela; Smales, Erik; Edwards, Bradley; Owens, Robert L.; Malhotra, Atul.

In: Sleep, Vol. 42, No. 6, zsz047, 06.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Is there a threshold that triggers cortical arousals in obstructive sleep apnea

AU - Li, Yanru

AU - Orr, Jeremy

AU - Jen, Rachel

AU - Sands, Scott A.

AU - DeYoung, Pamela

AU - Smales, Erik

AU - Edwards, Bradley

AU - Owens, Robert L.

AU - Malhotra, Atul

PY - 2019/6

Y1 - 2019/6

N2 - Study Objectives: To determine whether there is a consistent epiglottic pressure value that predicts respiratory arousal from sleep. Methods: Thirty-one patients with obstructive sleep apnea underwent overnight polysomnography while instrumented with an epiglottic catheter to measure airway pressures. Nadir epiglottic pressures during respiration events (obstructive apneas/hypopneas) terminated with or without arousals were compared. The events were selected by two methods, (1) 20 events with/without arousals were randomly selected, and (2) Events were sampled in pairs (one terminated with arousal and one without arousal) to minimize the effect of sleep duration/stage on the measurement. Results: A total of 1,317 respiratory events were analyzed. There was substantial variability in nadir epiglottic pressure within an individual and among different individuals. The average pressure of 20 randomly selected events with arousals was (-21.2 ± 11.2, ranged -6.68 to -63.34 cm H2O). The nadir epiglottic pressure during respiratory events in NREM stage 2 sleep terminated with arousals was more negative compared with those terminated without arousals using both sampling methods (-23.5 vs. -18.5 cm H2O, p = 0.007 and -20.3 vs. -16.3 cm H2O, p < 0.001). Conclusions: There were very different levels of epiglottic pressures that preceded arousals within and among individuals. However, cortical arousals are associated with a level of more negative epiglottic pressure compared to events terminated without arousal, findings which support the concept of a respiratory arousal threshold.

AB - Study Objectives: To determine whether there is a consistent epiglottic pressure value that predicts respiratory arousal from sleep. Methods: Thirty-one patients with obstructive sleep apnea underwent overnight polysomnography while instrumented with an epiglottic catheter to measure airway pressures. Nadir epiglottic pressures during respiration events (obstructive apneas/hypopneas) terminated with or without arousals were compared. The events were selected by two methods, (1) 20 events with/without arousals were randomly selected, and (2) Events were sampled in pairs (one terminated with arousal and one without arousal) to minimize the effect of sleep duration/stage on the measurement. Results: A total of 1,317 respiratory events were analyzed. There was substantial variability in nadir epiglottic pressure within an individual and among different individuals. The average pressure of 20 randomly selected events with arousals was (-21.2 ± 11.2, ranged -6.68 to -63.34 cm H2O). The nadir epiglottic pressure during respiratory events in NREM stage 2 sleep terminated with arousals was more negative compared with those terminated without arousals using both sampling methods (-23.5 vs. -18.5 cm H2O, p = 0.007 and -20.3 vs. -16.3 cm H2O, p < 0.001). Conclusions: There were very different levels of epiglottic pressures that preceded arousals within and among individuals. However, cortical arousals are associated with a level of more negative epiglottic pressure compared to events terminated without arousal, findings which support the concept of a respiratory arousal threshold.

KW - Arousal

KW - Epiglottic pressure

KW - Obstructive sleep apnea

KW - Respiratory arousal threshold

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