title: Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome.
abstract: OBJECTIVE
  The obstructive sleep apnea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered, imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Experimental inspiratory loading in normal subjects elicits respiratory-related cortical activity. The objective of this study was to test whether awake OSAS patients would exhibit a similar cortical activity.
  
  
  METHODS
  Descriptive physiology study.
  
  
  METHODS
  Sleep laboratory in a large university affiliated tertiary hospital.
  
  
  METHODS
  26 patients with moderate OSAS according to polysomnography (5 < apnea-hypopnea index [AHI] ≤ 30, n = 14) or severe OSAS (AHI > 30, n = 12); 13 non-OSAS patients for comparison.
  
  
  METHODS
  None.
  
  
  METHODS
  Respiratory time-locked electroencephalographic segments ensemble averaged and analyzed for slow premotor potentials preceding inspiration ("pre-inspiratory potentials" [PIPs]).
  
  
  RESULTS
  PIPs were present in 1/13 controls and 11/26 patients (P = 0.0336; 4/14 "moderate" and 7/12 "severe" patients). Awake OSAS patients therefore exhibit respiratory-related cortical activity during quiet breathing significantly more frequently than non-OSAS individuals. The corresponding PIPs resemble those observed during prepared voluntary inspirations and in response to experimental inspiratory loads in normal subjects, which involve a cortical network comprising the supplementary motor area.
  
  
  CONCLUSIONS
  A respiratory-related cortical activity could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in obstructive sleep apnea, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. Whether or not such cortical compensatory mechanisms have cognitive consequences remains to be determined.
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Launois
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Attali
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.
authors.forename: Marjolaine
authors.initials: M
authors.lastname: Georges
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Surveillance Post-Interventionnelle et d'Accueil des Polytraumatisés (Département d'Anesthésie Réanimation), Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Raux
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Morawiec
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|Ecole Supérieure de Physique et de Chimie de la Ville de Paris, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rivals
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.|AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
mesh_terms: D000328:Adult; D000368:Aged; D001143:Arousal; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000502:physiology*; D004328:Drive; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012119:Respiration; D012137:Respiratory System / Q000503:physiopathology; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D014851:Wakefulness / Q000502:physiology*
keywords: cerebral cortex; control of breathing; pre-inspiratory potentials; sleep apnea syndrome