Reply: Arousal threshold in obstructive sleep apnea

Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, Andrew Wellman

Research output: Contribution to journalLetterpeer-review

7 Citations (Scopus)


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.
Original languageEnglish
Pages (from-to)373-374
Number of pages2
JournalAmerican journal of respiratory and critical care medicine
Issue number3
Publication statusPublished - 1 Feb 2014
Externally publishedYes


  • respiratory arousal
  • thresholds
  • esophageal pressure


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