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2014 ; 16
(9
): 476
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Chemoreflexes, sleep apnea, and sympathetic dysregulation
#MMPMID25097113
Mansukhani MP
; Kara T
; Caples SM
; Somers VK
Curr Hypertens Rep
2014[Sep]; 16
(9
): 476
PMID25097113
show ga
Obstructive sleep apnea (OSA) and hypertension are closely linked conditions.
Disordered breathing events in OSA are characterized by increasing efforts
against an occluded airway while asleep, resulting in a marked sympathetic
response. This is predominantly due to hypoxemia activating the chemoreflexes,
resulting in reflex increases in sympathetic neural outflow. In addition, apnea -
and the consequent lack of inhibition of the sympathetic system that occurs with
lung inflation during normal breathing - potentiates central sympathetic outflow.
Sympathetic activation persists into the daytime, and is thought to contribute to
hypertension and other adverse cardiovascular outcomes. This review discusses
chemoreflex physiology and sympathetic modulation during normal sleep, as well as
the sympathetic dysregulation seen in OSA, its extension into wakefulness, and
changes after treatment. Evidence supporting the role of the peripheral
chemoreflex in the sympathetic dysregulation seen in OSA, including in the
context of comorbid obesity, metabolic syndrome, and systemic hypertension, is
reviewed. Finally, alterations in cardiovascular variability and other potential
mechanisms that may play a role in the autonomic imbalance in OSA are also
discussed.
|*Sleep
[MESH]
|Autonomic Nervous System Diseases/*etiology/physiopathology
[MESH]