We thank Professor Marcus for her interest in our study (1), and for highlighting these key arousal threshold studies in children with and without obstructive sleep apnea (OSA) (2). Our paper focused on adults. The pathophysiology of OSA in children may be quite different. Nonetheless, comparing potential differences and similarities in the varying causes of OSA between adults and children is of interest. In considering the role of arousal in sleep-disordered breathing pathogenesis across the lifespan, it is noteworthy that termination of obstructive respiratory events are rarely associated with cortical arousal in infants (<10%) (3), occur occasionally in children (<50%) (3, 4), and are present more frequently in adults (∼80%) (5). These divergences may reflect differences in arousal mechanisms, neuromuscular responses, or a combination of both. The timing of EEG arousal also often does not precisely coincide with airway opening in OSA (5, 6). Thus, EEG arousals are not required for airway opening in OSA and the upper airway muscles are capable of restoring airflow via noncortical arousal mechanisms, especially in infants.
|Number of pages||2|
|Journal||American journal of respiratory and critical care medicine|
|Publication status||Published - 1 Feb 2014|
- respiratory arousal
- esophageal pressure
Eckert, D. J., White, D. P., Jordan, A. S., Malhotra, A., & Wellman, A. (2014). Reply: Arousal threshold in obstructive sleep apnea. American journal of respiratory and critical care medicine, 189(3), 373-374. https://doi.org/10.1164/rccm.201312-2115LE