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Current Hypertension Reports
Published in: Current Hypertension Reports 9/2014

01-09-2014 | Hypertension and the Brain (S Stocker, Section Editor)

Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation

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

Published in: Current Hypertension Reports | Issue 9/2014

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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.
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Metadata
Title
Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation
Authors
Meghna P. Mansukhani
Tomas Kara
Sean M. Caples
Virend K. Somers
Publication date
01-09-2014
Publisher
Springer US
Published in
Current Hypertension Reports / Issue 9/2014
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-014-0476-2

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