Obstructive sleep apnea and respiratory center regulation abnormality
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • REVIEW
Obstructive sleep apnea and respiratory center regulation abnormality Liang Si 1 & Jing Zhang 1 & Yan Wang 1 & Jie Cao 1
&
Bao-yuan Chen 1 & Heng-juan Guo 1
Received: 18 November 2019 / Revised: 14 August 2020 / Accepted: 19 August 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose Obstructive sleep apnea (OSA) is a complex disease in which phenotypic analysis and understanding pathological mechanisms facilitate personalized treatment and outcomes. However, the pathophysiology responsible for this robust observation is incompletely understood. The objective of the present work was to review how respiratory center regulation varies during sleep and wakeness in patients with OSA. Data sources We searched for relevant articles up to December 31, 2019 in PubMed database. Methods This review examines the current literature on the characteristics of respiratory center regulation during wakefulness and sleep in OSA, detection method, and phenotypic treatment for respiratory center regulation. Results Mechanisms for ventilatory control system instability leading to OSA include different sleep stages in chemoresponsiveness to hypoxia and hypercapnia and different chemosensitivity at different time. One can potentially stabilize the breathing center in sleep-related breathing disorders by identifying one or more of these pathophysiological mechanisms. Conclusions Advancing mechanism research in OSA will guide symptom research and provide alternate and novel opportunities for effective treatment for patients with OSA. Keywords Respiratory center regulation . Obstructive sleep apnea . Detection method . Treatment
Introduction
Liang Si and Jing Zhang contributed equally to this work. The work for the following manuscript was conducted at Tianjin Medical University General Hospital. * Jie Cao [email protected] * Bao-yuan Chen [email protected] Liang Si [email protected] Jing Zhang [email protected] Yan Wang [email protected] Heng-juan Guo [email protected] 1
Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, China
In healthy individuals during wake time, the airway can remain open even if there is obvious anatomical stenosis. The respiratory center can produce effective compensation and distribute enough nerve impulses to stimulate the dilation of the pharyngeal muscle. Respiratory regulation during sleep involves complex physiological processes, which are different from those involved during wakefulness. After falling asleep, there is no awake stimulation, and metabolic demand becomes the main determinant of the minute respiratory volume. The upper airway muscle activity depends on local reflexes for mechanical information such as stimulation of afferent impulses (Fig. 1). Afferent impulses to the respiratory center, such as low O2 and high CO2, increase the resistance load and change the respiratory rhythm. Both increased and decreased respiratory center responses can lead to abnormal gas exchange such as hypoxemia, hyp
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