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Sastow T, Moussa N, Zebovitz E. Controversies in Sleep Apnea. Dent Clin North Am 2024; 68:1-20. [PMID: 37951627 DOI: 10.1016/j.cden.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
This chapter discusses controversies in diagnosis and management of obstructive sleep apnea (OSA), with particular focus on surgical management to improve quality of life. Though OSA is a complex disorder that affects millions of people worldwide, its management remains controversial among clinicians. Gaps in understanding its pathophysiology, long-term health consequences, diagnostic methods, and treatment strategies exist. While continuous positive airway pressure (CPAP) therapy is considered the gold standard for moderate to severe obstructive sleep apnea (OSA), its adherence rate is often low, and its efficacy in improving outcomes beyond symptom reduction and quality of life improvement is uncertain. As such, surgical intervention may be an alternative for specific patient populations. Additionally, the type of surgical intervention may depend on individual patient needs, anatomic features, as well as preferences.
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Affiliation(s)
- Tal Sastow
- Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 155 Ashland Pl, Brooklyn, NY 11201, USA.
| | - Nabil Moussa
- Oral and Maxillofacial Surgery, Anne Arundel Medical Center, 4311 Northview Drive, Bowie, MD 20716, USA
| | - Edward Zebovitz
- Oral and Maxillofacial Surgery, Anne Arundel Medical Center, 4311 Northview Drive, Bowie, MD 20716, USA
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Bark B, Nam B, Kim IY. SelANet: decision-assisting selective sleep apnea detection based on confidence score. BMC Med Inform Decis Mak 2023; 23:190. [PMID: 37735681 PMCID: PMC10514955 DOI: 10.1186/s12911-023-02292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND One of the most common sleep disorders is sleep apnea syndrome. To diagnose sleep apnea syndrome, polysomnography is typically used, but it has limitations in terms of labor, cost, and time. Therefore, studies have been conducted to develop automated detection algorithms using limited biological signals that can be more easily diagnosed. However, the lack of information from limited signals can result in uncertainty from artificial intelligence judgments. Therefore, we performed selective prediction by using estimated respiratory signals from electrocardiogram and oxygen saturation signals based on confidence scores to classify only those sleep apnea occurrence samples with high confidence. In addition, for samples with high uncertainty, this algorithm rejected them, providing a second opinion to the clinician. METHOD Our developed model utilized polysomnography data from 994 subjects obtained from Massachusetts General Hospital. We performed feature extraction from the latent vector using the autoencoder. Then, one dimensional convolutional neural network-long short-term memory (1D CNN-LSTM) was designed and trained to measure confidence scores for input, with an additional selection function. We set a confidence score threshold called the target coverage and performed optimization only on samples with confidence scores higher than the target coverage. As a result, we demonstrated that the empirical coverage trained in the model converged to the target coverage. RESULT To confirm whether the model has been optimized according to the objectives, the coverage violation was used to measure the difference between the target coverage and the empirical coverage. As a result, the value of coverage violation was found to be an average of 0.067. Based on the model, we evaluated the classification performance of sleep apnea and confirmed that it achieved 90.26% accuracy, 91.29% sensitivity, and 89.21% specificity. This represents an improvement of approximately 7.03% in all metrics compared to the performance achieved without using a selective prediction. CONCLUSION This algorithm based on selective prediction utilizes confidence measurement method to minimize the problem caused by limited biological information. Based on this approach, this algorithm is applicable to wearable devices despite low signal quality and can be used as a simple detection method that determine the need for polysomnography or complement it.
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Affiliation(s)
- Beomjun Bark
- Department of Biomedical Engineering, Hanyang University, 222, Wangsimni-Ro, Seongdong-Gu, 04763, Seoul, Republic of Korea
| | - Borum Nam
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - In Young Kim
- Department of Biomedical Engineering, Hanyang University, 222, Wangsimni-Ro, Seongdong-Gu, 04763, Seoul, Republic of Korea.
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Are We Underestimating the Central Components of the Mixed Apneas?-A Hypothesis for Revised Scoring. J Clin Neurophysiol 2023; 40:165-172. [PMID: 34049365 DOI: 10.1097/wnp.0000000000000869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Apneas are classified in three categories, as obstructive, central, and mixed types. Mixed apneas are calculated together with the obstructive events in diagnosing obstructive sleep apnea syndrome (SAS). The clinical significance of mixed apneas needs to be specified. METHODS Patients with obstructive SAS having an index of mixed apneas ≥5/hour were evaluated. A new approach was developed to score the mixed apneas, and calculated them together with either obstructive or central type of events, depending on their obstructive and central components. The relationship between the development of complex SAS and the indices of abnormal respiratory events per standard and revised scoring was evaluated. RESULTS Ten of 56 patients (17.9%) developed complex SAS at titration polysomnography. The mean index of mixed apneas per standard scoring was significantly higher in patients who did not develop complex SAS ( P = 0.006). The use of newly developed method in scoring mixed apneas resulted that three patients (5.4%) fulfilled the diagnostic criteria for the central SAS at first-night polysomnography ( P < 0.001), and all of them had developed complex SAS at titration night requiring other modes of positive airway pressure therapy than the continuous mode ( P = 0.004). Curve estimation models showed that the change from mixed apneas to central apneas was highly significant in patients developing complex SAS ( r2 = 0.501; P = 0.022). CONCLUSIONS Our study showed that the summation of mixed apneas with the obstructive events conventionally underestimates the central components and the diagnosis of central SAS, which are fundamental in the risk stratification of complex SAS.
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Yuan T, Zuo Z, Xu J. Lesions causing central sleep apnea localize to one common brain network. Front Neuroanat 2022; 16:819412. [PMID: 36249869 PMCID: PMC9559371 DOI: 10.3389/fnana.2022.819412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo characterize the specific brain regions for central sleep apnea (CSA) and identify its functional connectivity network.MethodsWe performed a literature search and identified 27 brain injuries causing CSA. We used a recently validated methodology termed “lesion network mapping” to identify the functional brain network subtending the pathophysiology of CSA. Two separate statistical approaches, the two-sample t-test and the Liebermeister test, were used to evaluate the specificity of this network for CSA through a comparison of our results with those of two other neurological syndromes. An additional independent cohort of six CSA cases was used to assess reproducibility.ResultsOur results showed that, despite lesions causing CSA being heterogeneous for brain localization, they share a common brain network defined by connectivity to the middle cingulate gyrus and bilateral cerebellar posterior lobes. This CSA-associated connectivity pattern was unique when compared with lesions causing the other two neurological syndromes. The CAS-specific regions were replicated by the additional independent cohort of six CSA cases. Finally, we found that all lesions causing CSA aligned well with the network defined by connectivity to the cingulate gyrus and bilateral cerebellar posterior lobes.ConclusionOur results suggest that brain injuries responsible for CSA are part of a common brain network defined by connectivity to the middle cingulate gyrus and bilateral cerebellar posterior lobes, lending insight into the neuroanatomical substrate of CSA.
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Affiliation(s)
- Taoyang Yuan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- University of Chinese Academy of Sciences, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- *Correspondence: Zhentao Zuo
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Jianguo Xu
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Helge AW, Hanif U, Joergensen VH, Jennum P, Mignot E, Sorensen HBD. Detection of Cheyne-Stokes Breathing using a transformer-based neural network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4580-4583. [PMID: 36086293 DOI: 10.1109/embc48229.2022.9871537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Annotation of sleep disordered breathing, including Cheyne-Stokes Breathing (CSB), is an expensive and time-consuming process for the clinician. To solve the problem, this paper presents a deep learning-based algorithm for automatic sample-wise detection of CSB in nocturnal polysomnographic (PSG) recordings. 523 PSG recordings were retrieved from four different sleep cohorts and subsequently scored for CSB by three certified sleep technicians. The data was pre-processed and 16 time domain features were extracted and passed into a neural network inspired by the transformer unit. Finally, the network output was post-processed to achieve physiologically meaningful predictions. The algorithm reached a F1-score of 0.76, close to the certified sleep technicians showing that it is possible to automatically detect CSB with the proposed model. The algorithm had difficulties distinguishing between severe obstructive sleep apnea and CSB but this was not dissimilar to technician performance. In conclusion, the proposed algorithm showed promising results and a confirmation of the performance could make it relevant as a screening tool in a clinical setting.
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Too Much of a Good Thing? Ann Am Thorac Soc 2021; 18:893-897. [PMID: 33929305 DOI: 10.1513/annalsats.202008-1030cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Adult Saethre-Chotzen Syndrome: A Unique Abnormal Breathing Pattern. J Craniofac Surg 2021; 32:e459-e461. [PMID: 33351546 DOI: 10.1097/scs.0000000000007357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT A 35-year-old male with Saethre-Chotzen syndrome presented with severe complaints. Neuroimaging showed a Chiari-I malformation, mild ventriculomegaly, a syrinx of the wide central canal, and various cerebral vascular anomalies including a large occipital emissary vein on the right. Ultrasound of this vein confirmed blocking of the outflow-track when turning his head to the right, which also provoked the headaches and bruit. Polysomnography revealed severe positional sleep apnea with a mixed breathing pattern, the central components consisted of periodic breathing with, at times, crescendo-decrescendo reminiscent of a Cheyne-Stokes versus Biot breathing pattern, pointing to possible brain stem/pontine problems. Continuous positive airway pressure was initiated, and the patient was instructed to avoid sleeping in the right lateral position. One year later, nearly all his complaints have resolved. A questionnaire was sent to all adult Saethre-Chotzen patients in our craniofacial unit, none reported any of the severe symptoms as described by our index case.
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Nasal high flow therapy in heart failure patients with central sleep apnea: a report of disproportional occurrence of cardiac arrhythmias. Sleep Med 2021; 79:119-121. [PMID: 33524836 DOI: 10.1016/j.sleep.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/30/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
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Costanzo MR, Javaheri S, Ponikowski P, Oldenburg O, Augostini R, Goldberg LR, Stellbrink C, Fox H, Schwartz AR, Gupta S, McKane S, Meyer TE, Abraham WT. Transvenous Phrenic Nerve Stimulation for Treatment of Central Sleep Apnea: Five-Year Safety and Efficacy Outcomes. Nat Sci Sleep 2021; 13:515-526. [PMID: 33953626 PMCID: PMC8092633 DOI: 10.2147/nss.s300713] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The remedē System Pivotal Trial was a prospective, multi-center, randomized trial demonstrating transvenous phrenic nerve stimulation (TPNS) therapy is safe and effectively treats central sleep apnea (CSA) and improves sleep architecture and daytime sleepiness. Subsequently, the remedē System was approved by FDA in 2017. As a condition of approval, the Post Approval Study (PAS) collected clinical evidence regarding long-term safety and effectiveness in adults with moderate to severe CSA through five years post implant. METHODS Patients remaining in the Pivotal Trial at the time of FDA approval were invited to enroll in the PAS and consented to undergo sleep studies (scored by a central laboratory), complete the Epworth Sleepiness Scale (ESS) questionnaire to assess daytime sleepiness, and safety assessment. All subjects (treatment and former control group) receiving active therapy were pooled; data from both trials were combined for analysis. RESULTS Fifty-three of the original 151 Pivotal Trial patients consented to participate in the PAS and 52 completed the 5-year visit. Following TPNS therapy, the apnea-hypopnea index (AHI), central-apnea index (CAI), arousal index, oxygen desaturation index, and sleep architecture showed sustained improvements. Comparing 5 years to baseline, AHI and CAI decreased significantly (AHI baseline median 46 events/hour vs 17 at 5 years; CAI baseline median 23 events/hour vs 1 at 5 years), though residual hypopneas were present. In parallel, the arousal index, oxygen desaturation index and sleep architecture improved. The ESS improved by a statistically significant median reduction of 3 points at 5 years. Serious adverse events related to implant procedure, device or delivered therapy were reported by 14% of patients which include 16 (9%) patients who underwent a pulse generator reposition or lead revision (primarily in the first year). None of the events caused long-term harm. No unanticipated adverse device effects or related deaths occurred through 5 years. CONCLUSION Long-term TPNS safely improves CSA, sleep architecture and daytime sleepiness through 5 years post implant. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01816776.
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Affiliation(s)
| | - Shahrokh Javaheri
- Bethesda North Hospital, Cincinnati, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | - Olaf Oldenburg
- Ludgerus-Kliniken Münster, Clemens Hospital, Münster, Germany
| | | | - Lee R Goldberg
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Henrik Fox
- Clinic for General and Interventional Cardiology Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Alan R Schwartz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sanjaya Gupta
- University of Missouri-Kansas City School of Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
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Straus C, Teulier M, Morel S, Wattiez N, Hajage D, Giboin C, Charbit B, Dasque E, Bodineau L, Chenuel B, Straus N, Attali V, Similowski T. Baclofen destabilises breathing during sleep in healthy humans: A randomised, controlled, double-blind crossover trial. Br J Clin Pharmacol 2020; 87:1814-1823. [PMID: 32986891 DOI: 10.1111/bcp.14569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/31/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS Periodic breathing is frequent in patients with severe heart failure. Apart from being an indicator of severity, periodic breathing has its own deleterious consequences (sleep-related oxygen desaturations, sleep fragmentation), which justifies attempts to correct it irrespective of the underlying disease. Animal models and human data suggest that baclofen can reconfigure respiratory central pattern generators. We hypothesised that baclofen, a GABAB agonist, may thus be able to correct periodic breathing in humans. METHODS Healthy volunteers were exposed to hypoxia during sleep. Participants who developed periodic breathing (n = 14 [53 screened]) were randomly assigned to double-blind oral baclofen (progressively increased to 60 mg/d) or placebo. The primary outcome was the coefficient of variation (CoVar) of respiratory cycle total time considered as an indicator of breathing irregularity. Secondary outcomes included the CoVar of tidal volume, apnoea-hypopnoea index, sleep fragmentation index and ventilatory complexity (noise limit). RESULTS The analysis was conducted in 9 subjects after exclusion of incomplete datasets. CoVar of respiratory cycle total time significantly increased with baclofen during non-rapid eye movement sleep (median with placebo 56.00% [37.63-78.95]; baclofen 85.42% [68.37-86.40], P = .020; significant difference during the N1-N2 phases of sleep but not during the N3 phase). CoVar of tidal volume significantly increased during N1-N2 sleep. The apnoea-hypopnoea index, sleep fragmentation index and ventilatory complexity were not significantly different between placebo and baclofen. CONCLUSION Baclofen did not stabilise breathing in our model. On the contrary, it increased respiratory variability. Baclofen should probably not be used in patients with or at risk of periodic breathing.
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Affiliation(s)
- Christian Straus
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Paris, France
| | - Marion Teulier
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sébastien Morel
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Nicolas Wattiez
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - David Hajage
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Unité de Recherche Clinique Salpêtrière-Charles Foix, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Paris, France
| | - Caroline Giboin
- AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Unité de Recherche Clinique Salpêtrière-Charles Foix, Paris, France
| | - Beny Charbit
- INSERM and AP-HP, CIC-1901 module Paris-Est, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,Department of Anesthesiology and Intensive Care, CHU Reims, Hôpital Robert Debré, Reims, France
| | - Eric Dasque
- INSERM and AP-HP, CIC-1901 module Paris-Est, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Laurence Bodineau
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Bruno Chenuel
- CHRU de Nancy, Service des Explorations Fonctionnelles Respiratoires et Centre Universitaire de Médecine du Sport et Activité Physique Adaptée, Vandoeuvre-lès-Nancy, France.,Faculté de Médecine de Nancy, EA DevAH - Universié de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nicolas Straus
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Valérie Attali
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Hôpital Pitié-Salpêtrière, Département R3S, Service des Pathologies du Sommeil, Paris, France
| | - Thomas Similowski
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Hôpital Pitié-Salpêtrière, Département R3S, Service de Pneumologie, Médecine Intensive et Réanimation, Paris, France
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Limanskaya AV, Busygina II, Levichkina EV, Pigarev IN. Complex Visceral Coupling During Central Sleep Apnea in Cats. Front Neurosci 2020; 14:568. [PMID: 32625050 PMCID: PMC7311805 DOI: 10.3389/fnins.2020.00568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/08/2020] [Indexed: 11/13/2022] Open
Abstract
Central sleep apnea is a sudden arrest of breathing during sleep caused by the central commands to the thoracoabdominal muscles. It is a widespread phenomenon in both healthy and diseased people, as well as in some animals. However, there is an ongoing debate whether it can be considered as a pathological deviation of the respiratory function or an adaptive mechanism of an unclear function. We performed chronic recordings from six behaving cats over multiple sleep/wake cycles, which included electroencephalogram, ECG, eye movements, air flow, and thoracic respiratory muscle movements, and in four cats combined that with the registration of myoelectric activity of the stomach and the duodenum. In these experiments, we observed frequent central cessations of breathing (for 5-13 s) during sleep. Each of the sleep apnea episodes was accompanied by a stereotypical complex of somatic and visceral effects. The heart rate increased 3-5 s before the respiration arrest and strongly decreased during the absence of respiration. The myoelectric activity of the stomach and the duodenum also often demonstrated a strong suppression during the apnea episodes. The general composition of the visceral effects was stable during all periods of observation (up to 3 years in one cat). We hypothesize that the stereotypic coupling of activities in various visceral systems during episodes of central sleep apnea most likely reflects a complex adaptive behavior rather than an isolated respiratory pathology and discuss the probable function of this phenomenon.
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Affiliation(s)
- Alexandra V. Limanskaya
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, Moscow, Russia
- Department of Higher Nervous Activity, Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Irina I. Busygina
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Ekaterina V. Levichkina
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, Moscow, Russia
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Ivan N. Pigarev
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, Moscow, Russia
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Lancaster G, Debevec T, Millet GP, Poussel M, Willis SJ, Mramor M, Goričar K, Osredkar D, Dolžan V, Stefanovska A. Relationship between cardiorespiratory phase coherence during hypoxia and genetic polymorphism in humans. J Physiol 2020; 598:2001-2019. [PMID: 31957891 PMCID: PMC7317918 DOI: 10.1113/jp278829] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Abstract
Key points High altitude‐induced hypoxia in humans evokes a pattern of breathing known as periodic breathing (PB), in which the regular oscillations corresponding to rhythmic expiration and inspiration are modulated by slow periodic oscillations. The phase coherence between instantaneous heart rate and respiration is shown to increase significantly at the frequency of periodic breathing during acute and sustained normobaric and hypobaric hypoxia. It is also shown that polymorphism in specific genes, NOTCH4 and CAT, is significantly correlated with this coherence, and thus with the incidence of PB. Differences in phase shifts between blood flow signals and respiratory and PB oscillations clearly demonstrate contrasting origins of the mechanisms underlying normal respiration and PB. These novel findings provide a better understanding of both the genetic and the physiological mechanisms responsible for respiratory control during hypoxia at altitude, by linking genetic factors with cardiovascular dynamics, as evaluated by phase coherence.
Abstract Periodic breathing (PB) occurs in most humans at high altitudes and is characterised by low‐frequency periodic alternation between hyperventilation and apnoea. In hypoxia‐induced PB the dynamics and coherence between heart rate and respiration and their relationship to underlying genetic factors is still poorly understood. The aim of this study was to investigate, through novel usage of time–frequency analysis methods, the dynamics of hypoxia‐induced PB in healthy individuals genotyped for a selection of antioxidative and neurodevelopmental genes. Breathing, ECG and microvascular blood flow were simultaneously monitored for 30 min in 22 healthy males. The same measurements were repeated under normoxic and hypoxic (normobaric (NH) and hypobaric (HH)) conditions, at real and simulated altitudes of up to 3800 m. Wavelet phase coherence and phase difference around the frequency of breathing (approximately 0.3 Hz) and around the frequency of PB (approximately 0.06 Hz) were evaluated. Subjects were genotyped for common functional polymorphisms in antioxidative and neurodevelopmental genes. During hypoxia, PB resulted in increased cardiorespiratory coherence at the PB frequency. This coherence was significantly higher in subjects with NOTCH4 polymorphism, and significantly lower in those with CAT polymorphism (HH only). Study of the phase shifts clearly indicates that the physiological mechanism of PB is different from that of the normal respiratory cycle. The results illustrate the power of time‐evolving oscillatory analysis content in obtaining important insight into high altitude physiology. In particular, it provides further evidence for a genetic predisposition to PB and may partly explain the heterogeneity in the hypoxic response. High altitude‐induced hypoxia in humans evokes a pattern of breathing known as periodic breathing (PB), in which the regular oscillations corresponding to rhythmic expiration and inspiration are modulated by slow periodic oscillations. The phase coherence between instantaneous heart rate and respiration is shown to increase significantly at the frequency of periodic breathing during acute and sustained normobaric and hypobaric hypoxia. It is also shown that polymorphism in specific genes, NOTCH4 and CAT, is significantly correlated with this coherence, and thus with the incidence of PB. Differences in phase shifts between blood flow signals and respiratory and PB oscillations clearly demonstrate contrasting origins of the mechanisms underlying normal respiration and PB. These novel findings provide a better understanding of both the genetic and the physiological mechanisms responsible for respiratory control during hypoxia at altitude, by linking genetic factors with cardiovascular dynamics, as evaluated by phase coherence.
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Affiliation(s)
| | - Tadej Debevec
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.,Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Gregoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Mathias Poussel
- Department of Pulmonary Function Testing and Exercise Physiology, CHRU de Nancy, Nancy, France
| | - Sarah J Willis
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Minca Mramor
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Hermand E, Pichon A, Lhuissier FJ, Richalet JP. Low-frequency ventilatory oscillations in hypoxia are a major contributor to the low-frequency component of heart rate variability. Eur J Appl Physiol 2019; 119:1769-1777. [PMID: 31154522 DOI: 10.1007/s00421-019-04166-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/19/2019] [Accepted: 05/23/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Heart rate variability (HRV) may be influenced by several factors, such as environment (hypoxia, hyperoxia, hypercapnia) or physiological demand (exercise). In this retrospective study, we tested the hypothesis that inter-beat (RR) intervals in healthy subjects exercising under various environmental stresses exhibit oscillations at the same frequency than ventilatory oscillations. METHODS Spectra from RR intervals and ventilation ([Formula: see text]E) were collected from 37 healthy young male subjects who participated in 5 previous studies focused on ventilatory oscillations (or periodic breathing) during exercise in hypoxia, hyperoxia and hypercapnia. Bland and Altman test and multivariate regressions were then performed to compare respective frequencies and changes in peak powers of the two signals. RESULTS Fast Fourier analysis of RR and [Formula: see text]E signals showed that RR was oscillating at the same frequency than periodic breathing, i.e., ~ 0.09 Hz (11 s). During exercise, in these various conditions, the difference between minimum and maximum HRV peak power was positively correlated to the same change in ventilation peak power (P < 0.05). Low-frequency (LF) peak power was correlated to tidal volume (P < 0.01) and breathing frequency (P < 0.001). CONCLUSIONS This study suggests that low-frequency ventilatory oscillations in hypoxia are a major contributor to the LF band power of heart rate variability. CLINICAL TRIAL REG. NO.: NCT02201875.
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Affiliation(s)
- Eric Hermand
- Laboratoire HAVAE 'Handicap, Activité, Vieillissement, Autonomie, Environnement', E6310, Université de Limoges, Faculté Des Sciences Et Techniques, 123 avenue Albert Thomas, 87060, Limoges Cedex, France.
- Sorbonne Paris Cité, Laboratoire "Hypoxie & Poumon", E2363, Université Paris 13, Bobigny, France.
| | - Aurélien Pichon
- Laboratoire MOVE, Université de Poitiers, E6314, Poitiers, France
| | - François J Lhuissier
- Sorbonne Paris Cité, Laboratoire "Hypoxie & Poumon", E2363, Université Paris 13, Bobigny, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Physiologie, Explorations Fonctionnelles Et Médecine du Sport, 93009, Bobigny, France
| | - Jean-Paul Richalet
- Sorbonne Paris Cité, Laboratoire "Hypoxie & Poumon", E2363, Université Paris 13, Bobigny, France
- Département Médical, Institut National de L'Expertise Et de La Performance, 75012, Paris, France
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Baillieul S, Revol B, Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Pépin JL. Diagnosis and management of central sleep apnea syndrome. Expert Rev Respir Med 2019; 13:545-557. [PMID: 31014146 DOI: 10.1080/17476348.2019.1604226] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Central sleep apnea (CSA) syndrome has gained a considerable interest in the sleep field within the last 10 years. It is overrepresented in particular subpopulations such as patients with stroke or heart failure. Early detection and diagnosis, as well as appropriate treatment of central breathing disturbances during sleep remain challenging. Areas covered: Based on a systematic review of CSA in adults the clinical evidence and polysomnographic patterns useful for discerning central from obstructive events are discussed. Current therapeutic indications of CSA and perspectives are presented, according to the type of respiratory disturbances during sleep, alterations in blood gases and ventilatory control. Expert opinion: The precise identification of central events during polysomnographic recording is mandatory. Therapeutic choices for CSA depend on the typology of respiratory disturbances observed by polysomnography, changes in blood gases and ventilatory control. In CSA with normocapnia and ventilatory instability, adaptive servo-ventilation is recommended. In CSA with hypercapnia and/or rapid-eye movement sleep hypoventilation, non-invasive ventilation is required. Further studies are required as strong evidence is lacking regarding the long-term consequences of CSA and the long-term impact of current treatment strategies.
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Affiliation(s)
- Sébastien Baillieul
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Bruno Revol
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Ingrid Jullian-Desayes
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Marie Joyeux-Faure
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Renaud Tamisier
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Jean-Louis Pépin
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
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15
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Affiliation(s)
- Kevin Gipson
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
| | - Mengdi Lu
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
| | - T Bernard Kinane
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
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16
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Granitza P, Kraemer JF, Schoebel C, Penzel T, Kurths J, Wessel N. Is dynamic desaturation better than a static index to quantify the mortality risk in heart failure patients with Cheyne-Stokes respiration? CHAOS (WOODBURY, N.Y.) 2018; 28:106312. [PMID: 30384661 DOI: 10.1063/1.5039601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/23/2018] [Indexed: 06/08/2023]
Abstract
Cheyne-Stokes respiration (CSR) is a periodic, highly dynamic, respiratory pattern and a known comorbidity in congestive heart failure (CHF) patients. It is generally seen as an indicator for a negative prognosis, even if no distinction in degree is known or understood. This paper aims to improve on existing attempts by creating a quantification of the behavior of the dynamic desaturation process of oxygen in the blood. We performed this work on a cohort of 11 subjects with CHF, reduced left ventricular ejection fraction, and CSR. The dynamic desaturation process was evaluated according to changes to peripheral capillary oxygenation S p O 2 resulting from highly nonlinear relationships in the ventilatory system perturbed by periodic breathing. Hypoxaemic burden expressed as a static index T 90 was compared to a novel relative desaturation index R D I , developed in this paper. While T 90 represents a single value calculated using a static cut-off value of 90 % S p O 2 , the R D I is more sensitive to dynamic influences as it uses the specific maximum change in saturation for each CSR episode. The threshold of T 90 = 22 min per night as suggested by Oldenburg et al. could not be confirmed to predict survival, but all central apneas resulting in a relative desaturation of S p O 2 above a cut-off value of 8 % were a 100 % positive predictor of mortality. The R D I proved sufficiently stable in intraindividual measurements across CSR epochs. Across the cohort, it showed a bimodal distribution for the deceased group, indicative of a possible aetiological difference. Hence, it is our conclusion that a dynamic approach to analyse desaturation of oxygen during Cheyne-Stokes respiration is to be strongly favoured over a static approach to analysis.
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Affiliation(s)
- Philine Granitza
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Christoph Schoebel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Thomas Penzel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Jürgen Kurths
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Niels Wessel
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
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Himanen SL, Martikkala L, Sulkamo S, Rutanen A, Huupponen E, Tenhunen M, Saunamäki T. Prolonged partial obstruction during sleep is a NREM phenomenon. Respir Physiol Neurobiol 2018; 255:43-49. [PMID: 29803760 DOI: 10.1016/j.resp.2018.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Prolonged partial obstruction (PPO) is a common finding in sleep studies. Although not verified, it seems to emerge in deep sleep. We study the effect of PPO on sleep architecture or sleep electroencephalography (EEG) frequency. METHODS Fifteen OSA patients, 15 PPO + OSA patients and 15 healthy subjects underwent a polysomnography. PPO was detected from Emfit mattress signal. Visual sleep parameters and median NREM sleep frequency of the EEG channels were evaluated. RESULTS The amount of deep sleep (N3) did not differ between the PPO + OSA and control groups (medians 11.8% and 13.8%). PPO + OSA-patients' N3 consisted mostly of PPO. PPO + OSA patients had lighter sleep than healthy controls in three brain areas (Fp2-A1, C4-A1, O1-A2, p-values < 0.05). CONCLUSION PPO evolved in NREM sleep and especially in N3 indicating that upper airway obstruction does not always ameliorate in deep sleep but changes the type. Even if PPO + OSA-patients had N3, their NREM sleep was lighter in three EEG locations. This might reflect impaired recovery function of sleep.
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Affiliation(s)
- Sari-Leena Himanen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Lauri Martikkala
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Saramia Sulkamo
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Rutanen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Eero Huupponen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Department of Medical Physics, Tampere University Hospital, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Tiia Saunamäki
- Tampere University Hospital, Department of Neurology and Rehabilitation, Tampere, Finland
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Phenotyping the pathophysiology of obstructive sleep apnea using polygraphy/polysomnography: a review of the literature. Sleep Breath 2018; 22:579-592. [PMID: 29318567 DOI: 10.1007/s11325-017-1613-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/03/2017] [Accepted: 12/19/2017] [Indexed: 12/19/2022]
Abstract
Continuous positive airway pressure (CPAP) is the first-line treatment for the majority of patients affected by obstructive sleep apnea syndrome (OSA). However, long-term compliance with CPAP therapy may result limited and alternatives to CPAP therapy are required to address the increasing need to provide tailored therapeutic options. Understanding the pathophysiological traits (PTs) of OSA patients [upper airway (UA) anatomical collapsibility, loop gain (LG), arousal threshold (AT), and UA gain (UAG)] lies at the heart of the customized OSA treatment. However, sleep research laboratories capable to phenotype OSA patients are sparse and the diagnostic procedures time-consuming, costly, and requiring significant expertise. The question arises whether the use of routine clinical polysomnography or nocturnal portable multi-channel monitoring (PSG/PM) can provide sufficient information to characterize the above traits. The aim of the present review is to deduce if the information obtainable from the clinical PSG/PM analysis, independently of the scope and context of the original studies, is clinically useful to define qualitatively the PTs of individual OSA patients. In summary, it is possible to identify four patterns using PSG/PM that are consistent with an altered UA collapsibility, three that are consistent with altered LG, two with altered AT, and three consistent with flow limitation/UA muscle response. Furthermore, some PSG/PM indexes and patterns, useful for the suitable management of OSA patient, have been discussed. The delivery of this clinical approach to phenotype pathophysiological traits will allow patients to benefit in a wider range of sleep services by facilitating tailored therapeutic options.
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19
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Annual review of selected scientific literature: Report of the committee on scientific investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2017; 118:281-346. [DOI: 10.1016/j.prosdent.2017.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/19/2023]
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20
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Schertel A, Horvath CM, Pichler Hefti J, Aubert JD, Brill AK. A 58-Year-Old Man With Position-Dependent Nocturnal Dyspnea. Chest 2017; 152:e51-e55. [DOI: 10.1016/j.chest.2017.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 12/01/2022] Open
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Abstract
This review aims to explain the inevitable imbalance between respiratory load, drive, and muscular force that occurs in the natural aging of Duchenne muscular dystrophy and that predisposes these patients to sleep disordered breathing (SDB). In DMD, SDB is characterized by oxygen desaturation, apneas, hypercapnia, and hypoventilation during sleep and ultimately develops into respiratory failure during wakefulness. It can be present in all age groups. Young patients risk obstructive apneas because of weight gain, secondary to progressive physical inactivity and prolonged corticosteroid therapy; older patients hypoventilate and desaturate because of respiratory muscle weakness, in particular the diaphragm. These conditions are further exacerbated during REM sleep, the phase of maximal muscle hypotonia during which the diaphragm has to provide most of the ventilation. Evidence is given to the daytime predictors of early symptoms of SDB, important indicators for the proper time to initiate mechanical ventilation.
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22
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Martinot JB, Borel JC, Le-Dong NN, Guénard HJP, Cuthbert V, Silkoff PE, Gozal D, Pepin JL. Monitoring mandibular movements to detect Cheyne-Stokes Breathing. Respir Res 2017; 18:66. [PMID: 28427400 PMCID: PMC5399309 DOI: 10.1186/s12931-017-0551-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/12/2017] [Indexed: 12/01/2022] Open
Abstract
Background The patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. Methods In 573 consecutive patients attending an in-laboratory PSG for suspected sleep disordered breathing (SDB), MM signals were acquired using magnetometry and scored manually while blinded from the PSG signal. Data analysis aimed to verify the concordance between the CSB identified by PSG and the presence of LPM or SPM. The data were randomly divided into training and validation sets (985 5-min segments/set) and concordance was evaluated using 2 classification models. Results In PSG, 22 patients (mean age ± SD: 65.9 ± 15.0 with a sex ratio M/F of 17/5) had CSB (mean central apnea hourly indice ± SD: 17.5 ± 6.2) from a total of 573 patients with suspected SDB. When tested on independent subset, the classification of CSB based on LPM and SPM is highly accurate (Balanced-accuracy = 0.922, sensitivity = 0.922, specificity = 0.921 and error-rate = 0.078). Logistic models based odds-ratios for CSB in presence of SPM or LPM were 172.43 (95% CI: 88.23–365.04; p < 0.001) and 186.79 (95% CI: 100.48–379.93; p < 0.001), respectively. Conclusion CSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.
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Affiliation(s)
- Jean-Benoît Martinot
- Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium.
| | - Jean-Christian Borel
- AGIR à dom. Association, 38240, Meylan, France.,University Grenoble Alpes, HP2 INSERM U1042, 38000, Grenoble, France
| | | | | | - Valerie Cuthbert
- Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium
| | | | | | - Jean-Louis Pepin
- University Grenoble Alpes, HP2 INSERM U1042, 38000, Grenoble, France.,CHU de Grenoble, Laboratoire EFCR, Pôle THORAX et VAISSEAUX, Grenoble, France
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23
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Shan LN, Chai WS, Lu SJ, Song YG, Su D, Yang S, Shi XB, Wang W. The significant effect of chronic intermittent hypoxia on prostaglandin D 2 biosynthesis in rat brain. Biochem Biophys Res Commun 2017; 483:283-287. [PMID: 28025147 DOI: 10.1016/j.bbrc.2016.12.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Li-Na Shan
- Department of Respiratory, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, 121001, China
| | - Wen-Shu Chai
- Department of Respiratory, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, 121001, China
| | - Si-Jing Lu
- Department of Respiratory, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, 121001, China
| | - Yong-Gui Song
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, 330004, China
| | - Dan Su
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, 330004, China
| | - Shuman Yang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Xian-Bao Shi
- Department of Respiratory, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, 121001, China.
| | - Wei Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
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