Semin Neurol 2009; 29(4): 368-371
DOI: 10.1055/s-0029-1237122
© Thieme Medical Publishers

Neurologic Aspects of Sleep Apnea: Is Obstructive Sleep Apnea a Neurologic Disorder?

Christian Guilleminault1 , Kannan Ramar1
  • 1Stanford Sleep Disorders Center of Excellence, Stanford University School of Medicine, Stanford, California
Further Information

Publication History

Publication Date:
09 September 2009 (online)

ABSTRACT

The upper airway caliber is determined by afferent sensory input to the brainstem respiratory centers and efferent motor neural output to the upper airway structures. Upper airway caliber is altered in obstructive sleep apnea. The mechanosensory receptors of the upper airway are capable of responding to changes in airway pressure, airflow, temperature, and to the upper airway muscle tone itself. Application of topical anesthesia change chronic snorers in apneic patients during sleep and prolong sleep apnea in obstructive sleep apnea (OSA) patients. Respiratory-related evoked potential are significantly reduced in OSA patients during non-rapid eye movement sleep indicating a sleep-related blunted cortical response to inspiratory occlusion. Histologic investigations of palatopharyngeal muscles from OSA patients show evidence of motor neuron lesions and actual damage to the muscles. Currently demonstrated local neurologic impairment and lesions can explain the development of sleep apneas and hypopneas.

REFERENCES

  • 1 Takeuchi T, Futatsuka M, Imanishi H, Yamada S. Pathological changes observed in the finger biopsy of patients with vibration-induced white finger.  Scand J Work Environ Health. 1986;  12(4 Spec No) 280-283
  • 2 Hwang J C, St John W M, Bartlett Jr D. Receptors responding to changes in upper airway pressure.  Respir Physiol. 1984;  55(3) 355-366
  • 3 Mathew O P, Sant'Ambrogio G, Fisher J T, Sant'Ambrogio F B. Laryngeal pressure receptors.  Respir Physiol. 1984;  57(1) 113-122
  • 4 Sant'Ambrogio G, Mathew O P, Fisher J T, Sant'Ambrogio F B. Laryngeal receptors responding to transmural pressure, airflow and local muscle activity.  Respir Physiol. 1983;  54(3) 317-330
  • 5 Mathew O P, Abu-Osba Y K, Thach B T. Influence of upper airway pressure changes on genioglossus muscle respiratory activity.  J Appl Physiol. 1982;  52(2) 438-444
  • 6 Mathew O P, Abu-Osba Y K, Thach B T. Genioglossus muscle responses to upper airway pressure changes: afferent pathways.  J Appl Physiol. 1982;  52(2) 445-450
  • 7 Abu-Osba Y K, Mathew O P, Thach B T. An animal model for airway sensory deprivation producing obstructive apnea with postmortem findings of sudden infant death syndrome.  Pediatrics. 1981;  68(6) 796-801
  • 8 DeWeese E L, Sullivan T Y. Effects of upper airway anesthesia on pharyngeal patency during sleep.  J Appl Physiol. 1988;  64(4) 1346-1353
  • 9 McNicholas W T, Coffey M, McDonell T et al.. Abnormal respiration during sleep in normal subjects following selective topical oropharyngeal and nasal anesthesia [abstract].  Am Rev Respir Dis. 1985;  131 302
  • 10 White D P, Cadieux R J, Lombard R M, Bixler E O, Kales A, Zwillich C W. The effects of nasal anesthesia on breathing during sleep.  Am Rev Respir Dis. 1985;  132(5) 972-975
  • 11 Basner R C, Ringler J, Garpestad E et al.. Upper airway anesthesia delays arousal from airway occlusion induced during human NREM sleep.  J Appl Physiol. 1992;  73(2) 642-648
  • 12 Issa F G, McNamara S G, Sullivan C E. Arousal responses to airway occlusion in sleeping dogs: comparison of nasal and tracheal occlusions.  J Appl Physiol. 1987;  62(5) 1832-1836
  • 13 Cala S J, Sliwinski P, Cosio M G, Kimoff R J. Effect of topical upper airway anesthesia on apnea duration through the night in obstructive sleep apnea.  J Appl Physiol. 1996;  81(6) 2618-2626
  • 14 Berry R B, Kouchi K G, Bower J L, Light R W. Effect of upper airway anesthesia on obstructive sleep apnea.  Am J Respir Crit Care Med. 1995;  151(6) 1857-1861
  • 15 Takeuchi T, Futatsuka M, Imanishi H, Yamada S. Pathological changes observed in the finger biopsy of patients with vibration-induced white finger.  Scand J Work Environ Health. 1986;  12(4 Spec No) 280-283
  • 16 Friberg D, Ansved T, Borg K, Carlsson-Nordlander B, Larsson H, Svanborg E. Histological indications of a progressive snorers disease in an upper airway muscle.  Am J Respir Crit Care Med. 1998;  157(2) 586-593
  • 17 Boyd J H, Petrof B J, Hamid Q, Fraser R, Kimoff R J. Upper airway muscle inflammation and denervation changes in obstructive sleep apnea.  Am J Respir Crit Care Med. 2004;  170(5) 541-546
  • 18 Friberg D, Gazelius B, Lindblad L E, Nordlander B. Habitual snorers and sleep apneics have abnormal vascular reactions of the soft palatal mucosa on afferent nerve stimulation.  Laryngoscope. 1998;  108(3) 431-436
  • 19 Kimoff R J, Sforza E, Champagne V, Ofiara L, Gendron D. Upper airway sensation in snoring and obstructive sleep apnea.  Am J Respir Crit Care Med. 2001;  164(2) 250-255
  • 20 Guilleminault C, Huang Y S, Kirisoglu C, Chan A. Is obstructive sleep apnea syndrome a neurological disorder? A continuous positive airway pressure follow-up study.  Ann Neurol. 2005;  58(6) 880-887
  • 21 Nguyen A T, Jobin V, Payne R, Beauregard J, Naor N, Kimoff R J. Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea.  Sleep. 2005;  28(5) 585-593
  • 22 Davenport P W, Friedman W A, Thompson F J, Franzén O. Respiratory-related cortical potentials evoked by inspiratory occlusion in humans.  J Appl Physiol. 1986;  60(6) 1843-1848
  • 23 Davenport P W, Shannon R, Mercak A, Reep R L, Lindsey B G. Cerebral cortical evoked potentials elicited by cat intercostal muscle mechanoreceptors.  J Appl Physiol. 1993;  74(2) 799-804
  • 24 Gora J, Trinder J, Pierce R, Colrain I. Evidence of a sleep specific blunted cortical response to inspiratory occlusions in mild obstructive sleep apnea syndrome.  Am J Respir Crit Care Med. 2002;  166 1225-1234
  • 25 Afifi L, Guilleminault C, Colrain I M. Sleep and respiratory stimulus specific dampening of cortical responsiveness in OSAS.  Respir Physiol Neurobiol. 2003;  136(2-3) 221-234
  • 26 Webster K E, Colrain I M. The relationship between respiratory-related evoked potentials and the perception of inspiratory resistive loads.  Psychophysiology. 2000;  37(6) 831-841
  • 27 Mortimore I L, Douglas N J. Palatal muscle EMG response to negative pressure in awake sleep apneic and control subjects.  Am J Respir Crit Care Med. 1997;  156(3 Pt 1) 867-873
  • 28 Fogel R B, Malhotra A, Pillar G et al.. Genioglossal activation in patients with obstructive sleep apnea versus control subjects. Mechanisms of muscle control.  Am J Respir Crit Care Med. 2001;  164 2025-2030
  • 29 Mezzanotte W S, Tangel D J, White D P. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls.  Am J Respir Crit Care Med. 1996;  153(6 Pt 1) 1880-1887
  • 30 Edström L, Larsson H, Larsson L. Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study.  J Neurol Neurosurg Psychiatry. 1992;  55(10) 916-920
  • 31 Woodson B T, Garancis J C, Toohill R J. Histopathologic changes in snoring and obstructive sleep apnea syndrome.  Laryngoscope. 1991;  101(12 Pt 1) 1318-1322
  • 32 Friberg D, Ansved T, Borg K, Carlsson-Nordlander B, Larsson H, Svanborg E. Histological indications of a progressive snorers disease in an upper airway muscle.  Am J Respir Crit Care Med. 1998;  157(2) 586-593

Christian GuilleminaultM.D. 

Professor of Psychiatry and Behavioral Sciences, Stanford Sleep Disorders Center of Excellence

Stanford University School of Medicine, 401 Quarry Road, Suite 3301, Stanford, CA 94305

Email: cguil@stanford.edu