Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation

Meghna P. Mansukhani, Tomas Kara, Sean M. Caples, Virend K. Somers

Research output: Contribution to journalReview article

52 Scopus citations

Abstract

Obstructive sleep apnea (OSA) and hypertension are closely linked conditions. Disordered breathing events in OSA are characterized by increasing efforts against an occluded airway while asleep, resulting in a marked sympathetic response. This is predominantly due to hypoxemia activating the chemoreflexes, resulting in reflex increases in sympathetic neural outflow. In addition, apnea – and the consequent lack of inhibition of the sympathetic system that occurs with lung inflation during normal breathing – potentiates central sympathetic outflow. Sympathetic activation persists into the daytime, and is thought to contribute to hypertension and other adverse cardiovascular outcomes. This review discusses chemoreflex physiology and sympathetic modulation during normal sleep, as well as the sympathetic dysregulation seen in OSA, its extension into wakefulness, and changes after treatment. Evidence supporting the role of the peripheral chemoreflex in the sympathetic dysregulation seen in OSA, including in the context of comorbid obesity, metabolic syndrome, and systemic hypertension, is reviewed. Finally, alterations in cardiovascular variability and other potential mechanisms that may play a role in the autonomic imbalance in OSA are also discussed.

Original languageEnglish (US)
Article number476
Pages (from-to)1-12
Number of pages12
JournalCurrent Hypertension Reports
Volume16
Issue number9
DOIs
StatePublished - Sep 1 2014

Keywords

  • Autonomic control
  • Autonomic dysfunction
  • Autonomic imbalance
  • Baroreflex
  • Cardiovascular variability
  • Carotid body
  • Heart rate variability
  • Hypercapnia
  • Hypoxia
  • Mechanisms
  • Metabolic syndrome
  • Obesity
  • Obstructive sleep apnea
  • Peripheral chemoreceptors
  • Renin angiotensin system
  • Sleep deprivation
  • Sleep disordered breathing
  • Sympathetic activation
  • Sympathetic activity
  • Sympathetic response
  • Sympathoexcitation
  • Systemic hypertension
  • Vascular factors

ASJC Scopus subject areas

  • Internal Medicine

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