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The recently described clinical syndrome of obstructive sleep apnea (OSAS), possibly affecting 2% to 10% of the adult population, is characterized by episodic sleep-induced changes in upper airway patency. These produce respiratory compromise ranging from partial to complete occlusion. Because obstruction represents a major challenge to homeostatic respiratory control mechanisms and because it can be completely reversed with a simple nasal mask/airway pressure device known as a nasal CPAP, OSAS provides an extraordinary opportunity to study control of breathing in humans.
Upper airway obstruction in OSAS results from interaction between subtle anatomic airway narrowing, increased wall collapsibility due sleep-induced loss of baseline muscle tone, and insufficient inspiratory phasic dilator muscle contraction to oppose the negative intraluminal pressure resulting from diaphragmatic contraction. This collapsible behavior can be modelled with a Starling resistor; exploring the properties of this model should provide insights into pathophysiology and treatment. One key observation is that a sinusoidally varying driving force (inspiratory diaphragmatic drive) acting through such a collapsible tube results in an inspiratory waveform which "flow limits." Although defined by pressure/flow relationships, flow limitation can be recognized by a flat contour of the inspiratory waveform in the flow/time display.
Appreciation of the information content of this easily obtained and noninvasive measurement has provided three research directions in our laboratory: 1) defining the role of the upper airway in sleep-related changes in respiratory control in normal subjects and patients with cardiorespiratory failure resulting in apnea and chronic hypercapnia; 2) developing diagnostic techniques to screen patients for the occurrence of sleep-related respiratory abnormalities; and 3) developing a technique for closed-loop computer-controlled regulation of the treatment for OSAS, e.g., a variation on nasal CPAP which automatically seeks the optimal pressure on a continuous basis.
Obstructive Sleep-Disordered Breathing Is More Common than Central in Mild Familial Dysautonomia
Hilz, Max J; Moeller, Sebastian; Buechner, Susanne; Czarkowska, Hanna; Ayappa, Indu; Axelrod, Felicia B; Rapoport, David M. Obstructive Sleep-Disordered Breathing Is More Common than Central in Mild Familial Dysautonomia. Journal of clinical sleep medicine : JCSM. 2016 Dec 15;12(12):1607-1614 (2386372)
Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial
Williams, Natasha J; Robbins, Rebecca; Rapoport, David; Allegrante, John P; Cohall, Alwyn; Ogedgebe, Gbenga; Jean-Louis, Girardin. Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial. Trials. 2016 Dec 08;17(1):585-585 (2353802)
Reduced Slow-Wave Sleep Is Associated with High Cerebrospinal Fluid Abeta42 Levels in Cognitively Normal Elderly
Varga, Andrew W; Wohlleber, Margaret E; Gimenez, Sandra; Romero, Sergio; Alonso, Joan F; Ducca, Emma L; Kam, Korey; Lewis, Clifton; Tanzi, Emily B; Tweardy, Samuel; Kishi, Akifumi; Parekh, Ankit; Fischer, Esther; Gumb, Tyler; Alcolea, Daniel; Fortea, Juan; Lleo, Alberto; Blennow, Kaj; Zetterberg, Henrik; Mosconi, Lisa; Glodzik, Lidia; Pirraglia, Elizabeth; Burschtin, Omar E; de Leon, Mony J; Rapoport, David M; Lu, Shou-En; Ayappa, Indu; Osorio, Ricardo S. Reduced Slow-Wave Sleep Is Associated with High Cerebrospinal Fluid Abeta42 Levels in Cognitively Normal Elderly. Sleep. 2016 Nov 01;39(11):2041-2048 (2310172)
Asthma and Subjective Sleep Disordered Breathing in a Large Cohort of Urban Adolescents
Zandieh, Stephanie O; Cespedes, Amarilis; Ciarleglio, Adam; Bourgeois, Wallace; Rapoport, David M; Bruzzese, Jean-Marie. Asthma and Subjective Sleep Disordered Breathing in a Large Cohort of Urban Adolescents. Journal of asthma. 2016 Oct 14;:0-0 (2278542)
Unique medical issues in adult patients with mucopolysaccharidoses
Mitchell, John; Berger, Kenneth I; Borgo, Andrea; Braunlin, Elizabeth A; Burton, Barbara K; Ghotme, Kemel A; Kircher, Susanne G; Molter, David; Orchard, Paul J; Palmer, James; Pastores, Gregory M; Rapoport, David M; Wang, Raymond Y; White, Klane. Unique medical issues in adult patients with mucopolysaccharidoses. European journal of internal medicine. 2016 Oct;34:2-10 (2145022)