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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.
Physiological and psychological factors influencing continuous positive airway pressure (CPAP) use in world trade center (WTC) responders with Obstructive Sleep Apnea (OSA)
Ducca, E L; Twumasi, A; Gumb, T; Perez, A; Lewis, C P; Patel, R; Alimokhtari, S; Black, K; Chitkara, N; Sunderram, J; Rapoport, D M; Ayappa, I. Physiological and psychological factors influencing continuous positive airway pressure (CPAP) use in world trade center (WTC) responders with Obstructive Sleep Apnea (OSA) [Meeting Abstract]. Sleep. 2016 2016;39:A158-A158 (2152902)
Pattern of CPAP use differs in mild and positional OSA: Preliminary results from the WTC SNORE Study
Gupta, S; Ducca, E L; Gumb, T; Twumasi, A; Perez, A; Black, K; Lu, S; Rapoport, D M; Ayappa, I; Alimokhtari, S; Sunderram, J. Pattern of CPAP use differs in mild and positional OSA: Preliminary results from the WTC SNORE Study [Meeting Abstract]. Sleep. 2016 2016;39:A152-A152 (2152912)
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 Jun 11;34:2-10 (2145022)
Orexin-A is Associated With Increases in Cerebrospinal Fluid Phosphorylated-Tau in Cognitively Normal Elderly Subjects
Osorio, Ricardo S; Ducca, Emma L; Wohlleber, Margaret E; Tanzi, Emily B; Gumb, Tyler; Twumasi, Akosua; Tweardy, Samuel; Lewis, Clifton; Fischer, Esther; Koushyk, Viachaslau; Cuartero-Toledo, Maria; Sheikh, Mohammed O; Pirraglia, Elizabeth; Zetterberg, Henrik; Blennow, Kaj; Lu, Shou-En; Mosconi, Lisa; Glodzik, Lidia; Schuetz, Sonja; Varga, Andrew W; Ayappa, Indu; Rapoport, David M; de Leon, Mony J. Orexin-A is Associated With Increases in Cerebrospinal Fluid Phosphorylated-Tau in Cognitively Normal Elderly Subjects. Sleep. 2016 Jun 1;39(6):1253-1260 (2046522)
POINT: Is the Apnea-Hypopnea Index the Best Way to Quantify the Severity of Sleep-Disordered Breathing? Yes
Rapoport, David M. POINT: Is the Apnea-Hypopnea Index the Best Way to Quantify the Severity of Sleep-Disordered Breathing? Yes [Editorial]. Chest. 2016 Jan 6;149(1):14-16 (1936722)