title: The cholinergic system may play a role in the pathophysiology of residual excessive sleepiness in patients with obstructive sleep apnea.
abstract: Obstructive sleep apnea (OSA) is a prevalent condition characterized by momentary cessations in breathing during sleep due to intermittent obstruction of the upper airway. OSA has been frequently associated with a number of medical comorbidities. CPAP (continuous positive airway pressure) is the gold standard treatment and is known to improve OSA symptoms, including excessive sleepiness. However, 12-14% of CPAP-treated patients continue to complain of sleepiness despite normalization of ventilation during sleep, and 6% after exclusion of other causes of EDS. This is of great concern because EDS is strongly associated with systemic health disorders, lower work performance, and a high risk of accidents. We hypothesized that decreased central cholinergic activity plays a role in the pathophysiology of residual excessive sleepiness in patients with OSA treated with CPAP. Acetylcholine (Ach) plays a large role in wakefulness physiology, and its levels are reduced in sleepiness. Herein, we discuss the potential role of the cholinergic system in this new clinical condition.
authors.affiliation: Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 925. Vila Clementino, Sao Paulo, SP 04024-002, Brazil. otuyamajun@gmail.com
authors.forename: Leonardo J
authors.initials: LJ
authors.lastname: Otuyama
authors.forename: Camila F
authors.initials: CF
authors.lastname: Rizzi
authors.forename: Ronaldo D
authors.initials: RD
authors.lastname: Piovezan
authors.forename: Ksdy S
authors.initials: KS
authors.lastname: Werli
authors.forename: Evelyn L
authors.initials: EL
authors.lastname: Brasil
authors.forename: Lucia
authors.initials: L
authors.lastname: Sukys-Claudino
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.forename: Dalva
authors.initials: D
authors.lastname: Poyares
mesh_terms: D000109:Acetylcholine / Q000378:metabolism*; D045422:Continuous Positive Airway Pressure / Q000379:methods; D006970:Disorders of Excessive Somnolence / Q000209:etiology*; D006801:Humans; D008954:Models, Biological; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy
chemical_list: D000109:Acetylcholine