Review
Central and peripheral factors contributing to obstructive sleep apneas

https://doi.org/10.1016/j.resp.2013.06.004Get rights and content
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Highlights

  • We review the central and peripheral contributions to obstructive sleep apnea.

  • We examine the dynamic interactions between central pre-motor elements and motor output that give rise to obstructive sleep apnea.

  • We discuss the complex interplay between both peripheral and central components that cause apneas.

Abstract

Apnea, the cessation of breathing, is a common physiological and pathophysiological phenomenon. Among the different forms of apnea, obstructive sleep apnea (OSA) is clinically the most prominent manifestation. OSA is characterized by repetitive airway occlusions that are typically associated with peripheral airway obstructions. However, it would be an oversimplification to conclude that OSA is caused by peripheral obstructions. OSA is the result of a dynamic interplay between chemo- and mechanosensory reflexes, neuromodulation, behavioral state and the differential activation of the central respiratory network and its motor outputs. This interplay has numerous neuronal and cardiovascular consequences that are initially adaptive but in the long-term become major contributors to morbidity and mortality. Not only OSA, but also central apneas (CA) have multiple, and partly overlapping mechanisms. In OSA and CA the underlying mechanisms are neither “exclusively peripheral” nor “exclusively central” in origin. This review discusses the complex interplay of peripheral and central nervous components that characterizes the cessation of breathing.

Keywords

Sleep Apnea
Airway
PreBotzinger complex
Respiration

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