Sleep Apnea As a Public Health Burden

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Sleep Apnea As a Public Health Burden

• Prevalence
• 2-3 of Children
• 4-7 of Middle Aged Adults
• 10-15 65 years

• Consequences
• Cardiovascular Disease
• Cognitive / Behavioral / Neural Deficits
• Cerebellar / Cortical Grey Matter Loss

Intermittant Hypoxia!!
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• Causes/Risk Factors for Sleep Apnea
• Airway Anatomy
• Neural Control
• Interactions

Skeletal Dimensions Pharyngeal Fat
airway
pump
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Independent Contributions of Airway Skeletal
Dimensions and Obesity to Sleep Apnea

• N204, clinical and non-clinical male subjects,
  age 35-65, AHI 0-100/hr.
• Overnight polysomnogram
• Lateral cephelograms, upright supine 41
  landmarks, 40 distances 15 angles BMI
• Stepwise regression for independent contributions
  to apnea/hypopnea

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A Narrowed Maxillary Dimension Increases the Odds
of Moderate/Severe Sleep Apnea by

• 6X in the Non-Obese
• 4.5X in the Obese

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Regression Analysis of Independent Contributions
To Sleep Apnea/Hypopnea
BMI X Maxilla
Maxilla Skeletal Dimension
Neural Control??
Body Mass Index
Age
N204 clinical and non-clinical subjects
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• Causes/Risk Factors for Sleep Apnea
• Airway Anatomy
• Neural Control
• Interactions

Skeletal Dimensions Pharyngeal Fat
airway
pump
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CHF Periodic Breathing
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Hypoxic Periodic Breathing
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Mixed Central Obstructive Apneas
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Flow (l/sec)
Peso (mmHg)
Spontaneous Central Apnea
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Flow (l/sec)
Peso (mmHg)
Spontaneous Central Apnea
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Flow (l/sec)
Peso (mmHg)
Spontaneous Central Apnea ? Airway Closure
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Flow (l/sec)
Peso (mmHg)
Spontaneous Central Apnea ? Airway Closure
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Flow (l/sec)
Peso (mmHg)
Spontaneous Central Apnea ? Airway Closure
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Unmasking A Sleep-Induced Hypocapnic Apneic
Threshold
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Non-REM Hypoxia
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Apneic Threshold (AT) in Sleep

• Hypocapnia Role
• Carotid vs. Central Chemoreception
• Plasticity of the AT
• Apnea Duration and Control System Inertia
• Central Instability Airway Obstruction

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Congestive Heart Failure and the Apneic Threshold

• 19 CHF Patients, LVEF 23-35, with and without
  periodic breathing (CSR)
• Determine waking and sleeping eupneic PACO2 and
  Apneic threshold PACO2 (via PSV)

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Congestive Heart Failure
CHF
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Congestive Heart Failure
CHFCSR
CHF
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• Causes/Risk Factors for Sleep Apnea
• Airway Anatomy
• Neural Control
• Interactions

Skeletal Dimensions Pharyngeal Fat
airway
pump
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The Apneic Threshold in Sleep Causes, Plasticity
and Consequences

• John Rankin Laboratory of Pulmonary Medicine
• University of Wisconsin - Madison

Curtis Smith Hideaki Nakayama Josh Rodman Bruno
Chenel
James Skatrud Ailing Xie Tadeusz Pryzbylowski
Tony Rice Safwan Badr