title: Central and peripheral factors contributing to obstructive sleep apneas.
abstract: Apnea, the cessation of breathing, is a common physiological and pathophysiological phenomenon. Among the different forms of apnea, obstructive sleep apnea (OSA) is clinically the most prominent manifestation. OSA is characterized by repetitive airway occlusions that are typically associated with peripheral airway obstructions. However, it would be an oversimplification to conclude that OSA is caused by peripheral obstructions. OSA is the result of a dynamic interplay between chemo- and mechanosensory reflexes, neuromodulation, behavioral state and the differential activation of the central respiratory network and its motor outputs. This interplay has numerous neuronal and cardiovascular consequences that are initially adaptive but in the long-term become major contributors to morbidity and mortality. Not only OSA, but also central apneas (CA) have multiple, and partly overlapping mechanisms. In OSA and CA the underlying mechanisms are neither "exclusively peripheral" nor "exclusively central" in origin. This review discusses the complex interplay of peripheral and central nervous components that characterizes the cessation of breathing.
authors.affiliation: Center for Integrative Brain Research, Seattle Children's Research Institute, Department of Neurological Surgery and Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: nino1@uw.edu.
authors.forename: Jan-Marino
authors.initials: JM
authors.lastname: Ramirez
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Garcia
authors.forename: Tatiana M
authors.initials: TM
authors.lastname: Anderson
authors.forename: Jenna E
authors.initials: JE
authors.lastname: Koschnitzky
authors.forename: Ying-Jie
authors.initials: YJ
authors.lastname: Peng
authors.forename: Ganesh K
authors.initials: GK
authors.lastname: Kumar
authors.forename: Nanduri R
authors.initials: NR
authors.lastname: Prabhakar
mesh_terms: D001143:Arousal / Q000502:physiology; D006801:Humans; D007002:Hypoglossal Nerve / Q000502:physiology; D009415:Nerve Net / Q000502:physiology*; D010791:Phrenic Nerve / Q000502:physiology; D017286:Polysomnography / Q000379:methods; D015656:Respiratory Mechanics / Q000502:physiology*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology*
keywords: Airway; PreBotzinger complex; Respiration; Sleep Apnea