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Sleep. 2019 Feb 22. pii: zsz047. doi: 10.1093/sleep/zsz047. [Epub ahead of print]

Is there a Threshold that Triggers Cortical Arousals in Obstructive Sleep Apnea.

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Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China.
Pulmonary, Critical Care and Sleep Division. University of California at San Diego, CA, United States.
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston MA, United States.
Department of Allergy Immunology and Respiratory Medicine and Central Clinical School, The Alfred and Monash University, Melbourne, Australia.



To determine whether there is a consistent epiglottic pressure value that predicts respiratory arousal from sleep.


31 patients with obstructive sleep apnea underwent overnight polysomnography while instrumented with an epiglottic catheter to measure airway pressures. Nadir epiglottic pressures during respiration events (obstructive apneas/hypopneas) terminated with or without arousals were compared. The events were selected by two methods, 1) 20 events with/without arousals were randomly selected, and 2) Events were sampled in pairs (one terminated with arousal and one without arousal) to minimize the effect of sleep duration/stage on the measurement.


A total of 1317 respiratory events were analyzed. There was substantial variability in nadir epiglottic pressure within an individual and among different individuals. The average pressure of 20 randomly selected events with arousals was (-21.2±11.2, ranged -6.68~-63.34cmH2O). The nadir epiglottic pressure during respiratory events in NREM stage 2 sleep terminated WITH arousals was more negative compared with those terminated without arousals using both sampling methods (-23.5 vs -18.5 cm H2O, p= 0.007 and -20.3 vs -16.3 cm H2O p<0.001).


There were very different levels of epiglottic pressures that preceded arousals within and among individuals. However, cortical arousals are associated with a level of more negative epiglottic pressure compared to events terminated without arousal, findings which support the concept of a respiratory arousal threshold.


Arousal; Epiglottic pressure; Obstructive Sleep Apnea; Respiratory Arousal T; hreshold


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