TY - JOUR
T1 - Reply
T2 - Arousal threshold in obstructive sleep apnea
AU - Eckert, Danny J.
AU - White, David P.
AU - Jordan, Amy S.
AU - Malhotra, Atul
AU - Wellman, Andrew
PY - 2014/2/1
Y1 - 2014/2/1
N2 - 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.
AB - 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.
KW - respiratory arousal
KW - thresholds
KW - esophageal pressure
UR - http://purl.org/au-research/grants/NHMRC/510392
UR - http://purl.org/au-research/grants/NHMRC/1049814
UR - http://www.scopus.com/inward/record.url?scp=84893545431&partnerID=8YFLogxK
U2 - 10.1164/rccm.201312-2115LE
DO - 10.1164/rccm.201312-2115LE
M3 - Letter
SN - 1073-449X
VL - 189
SP - 373
EP - 374
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 3
ER -