A Mechanism for Upper Airway Stability during Slow Wave Sleep

McSharry, David G.; Saboisky, Julian P.; DeYoung, Pamela; Matteis, Paul; Jordan, Amy S.; Trinder, John; Smales, Erik; Hess, L; Guo, Meng; Malhotra, Atul

doi:10.5665/sleep.2544

Cited by 40 publications

(39 citation statements)

References 28 publications

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“…Slow wave sleep (SWS) has been found to be associated with decreased severity of sleep apnea [52, 53]. In the study by McSharry et al [53] this effect was thought to be related to the increased genioglossus single motor unit activity during SWS, making the airway more stable and resistant to collapse.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Exercise Training on Sleep Apnea: A Meta-analysis

Iftikhar

Kline

Youngstedt

2013

Lung

195

137

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Background Several studies have shown a favorable effect of supervised exercise training on obstructive sleep apnea (OSA). This meta-analysis was conducted to analyze the data from these studies on the severity of OSA (primary outcome) in adults. Secondary outcomes of interest included body mass index (BMI), sleep efficiency, daytime sleepiness and cardiorespiratory fitness. Methods Two independent reviewers searched PubMed and Embase (from inception to March 6, 2013) to identify studies on the effects of supervised exercise training in adults with OSA. Pre- and postexercise training data on our primary and secondary outcomes were extracted. Results A total of 5 studies with 6 cohorts that enrolled a total of 129 study participants met the inclusion criteria. The pooled estimate of mean pre- to postintervention (exercise) reduction in AHI was −6.27 events/h (95 % confidence interval [CI] −8.54 to −3.99; p < 0.001). The pooled estimates of mean changes in BMI, sleep efficiency, Epworth sleepiness scale and VO2 peak were −1.37 (95 % CI −2.81 to 0.07; p = 0.06), 5.75 % (95 % CI 2.47–9.03; p = 0.001), −3.3 (95 % CI −5.57 to −1.02; p = 0.004), and 3.93 mL/kg/min (95 % CI 2.44–5.42; p < 0.001), respectively. Conclusions This meta-analysis shows a statistically significant effect of exercise in reducing the severity of sleep apnea in patients with OSA with minimal changes in body weight. Additionally, the significant effects of exercise on cardiorespiratory fitness, daytime sleepiness, and sleep efficiency indicate the potential value of exercise in the management of OSA.

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Section: Discussionmentioning

confidence: 99%

“…In the study by McSharry et al [53] this effect was thought to be related to the increased genioglossus single motor unit activity during SWS, making the airway more stable and resistant to collapse. It also is known that exercise training is associated with increased SWS [15].…”

Section: Discussionmentioning

confidence: 99%

Effects of Exercise Training on Sleep Apnea: A Meta-analysis

Iftikhar

Kline

Youngstedt

2013

Lung

195

137

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“…Breathing control is relatively stable in slow-wave sleep, and the upper airway is considered to be more vulnerable to collapse during REM (24,25). Thus, change in sleep architecture may also be related to the severity of sleep apnea.…”

Section: Original Researchmentioning

confidence: 99%

The Effect of Donepezil on Arousal Threshold and Apnea–Hypopnea Index. A Randomized, Double-Blind, Cross-Over Study

Owens

Sands

et al. 2016

Annals ATS

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Rationale: Obstructive sleep apnea (OSA) has multiple pathophysiological causes. A low respiratory arousal threshold (ArTh) and a high loop gain (unstable ventilatory control) can contribute to recurrent respiratory events in patients with OSA. Prior studies have shown that donepezil, an acetylcholinesterase inhibitor, might improve OSA, but the mechanism is unknown.Objectives: To determine whether a single dose of donepezil lowers the apnea-hypopnea index by modulating the ArTh or loop gain. Methods:In this randomized, double-blind, crossover trial, 41 subjects with OSA underwent two polysomnograms with ArTh and loop gain evaluated, during which 10 mg of donepezil or placebo was administered.Measurements and Main Results: Compared with placebo, sleep efficiency (77.2 vs. 71.9%; P = 0.015) and total sleep time decreased with donepezil (372 vs. 351 min; P = 0.004). No differences were found in apnea-hypopnea index (51.8 vs. 50.0 events/h; P = 0.576) or nadir oxygen saturation as determined by pulse oximetry (80.3 vs. 81.1%; P = 0.241) between placebo and donepezil, respectively. ArTh was not significantly changed (-18.9 vs. -18.0 cm H 2 O; P = 0.394) with donepezil. As a whole group, loop gain (ventilatory response to a 1-cycle/min disturbance) did not change significantly (P = 0.089).Conclusions: A single dose of donepezil did not appear to affect the overall severity of OSA in this patient group, and no consistent effects on ArTh or loop gain were observed. Donepezil may have minor effects on sleep architecture.Clinical trial registered with www.clinicaltrials.gov (NCT02264353).

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“…dilators that keep the upper airway open, they are of great significance in evaluating clinically respiratory function [1]. The measurement of GG electromyography (EMG) has caught widespread attention.…”

Section: T Song Et Al / Detection Of Genioglossus Myoelectric Activmentioning

confidence: 99%

Detection of genioglossus myoelectric activity using ICA of multi-channel mandible sEMG

Song

Meng

Chen

et al. 2015

THC

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Abstract. BACKGROUND:Genioglossus myoelectric activity is of great significance in evaluating clinical respiratory function. However, there is a tradeoff in genioglossus EMG measurement with respect to accuracy versus convenience. OBJECTIVE: This paper presents a way to separate the characteristics of genioglossus myoelectric activity from multi-channel mandible sEMG through independent component analysis. METHODS: First, intra-oral genioglossus EMGgenioglossus EMG and three-channel mandible sEMG were recorded simultaneously. The FastICA algorithm was applied to three independent components from the sEMG signals. Then the independent components with the intra-oral genioglossus EMG were compared by calculating the Pearson correlation coefficient between them. RESULTS: An examination of 60 EMG samples showed that the FastICA algorithm was effective in separating the characteristics of genioglossus myoelectric activity from multi-channel mandible sEMG. The results of analysis were coincident with clinical diagnosis through intra-oral electrodes. CONCLUSIONS: Genioglossus myoelectric activity can be evaluated accurately by multi-channel mandible sEMG, which is non-invasive and easy to record.

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A Mechanism for Upper Airway Stability during Slow Wave Sleep

Abstract: Increased genioglossus SMU activity likely makes the airway more stable and resistant to collapse throughout the respiratory cycle during SWS.

Cited by 40 publications

References 28 publications

Effects of Exercise Training on Sleep Apnea: A Meta-analysis

Effects of Exercise Training on Sleep Apnea: A Meta-analysis

The Effect of Donepezil on Arousal Threshold and Apnea–Hypopnea Index. A Randomized, Double-Blind, Cross-Over Study

Detection of genioglossus myoelectric activity using ICA of multi-channel mandible sEMG

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