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Yan L, Li H, Qian Y, Zhang J, Cong S, Zhang X, Wu L, Wang Y, Wang M, Yu T. Transcutaneous vagus nerve stimulation: a new strategy for Alzheimer's disease intervention through the brain-gut-microbiota axis? Front Aging Neurosci 2024; 16:1334887. [PMID: 38476661 PMCID: PMC10927744 DOI: 10.3389/fnagi.2024.1334887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Transcutaneous vagus nerve stimulation (tVNS) is an emerging non-invasive technique designed to stimulate branches of the vagus nerve distributed over the body surface. Studies suggest a correlation between the brain-gut-microbiota (BGM) axis and the pathogenesis of Alzheimer's disease (AD). The BGM axis represents a complex bidirectional communication system, with the vagus nerve being a crucial component. Therefore, non-invasive electrical stimulation of the vagus nerve might have the potential to modify-most of the time probably in a non-physiological way-the signal transmission within the BGM axis, potentially influencing the progression or symptoms of AD. This review explores the interaction between percutaneous vagus nerve stimulation and the BGM axis, emphasizing its potential effects on AD. It examines various aspects, such as specific brain regions, gut microbiota composition, maintenance of intestinal environmental homeostasis, inflammatory responses, brain plasticity, and hypothalamic-pituitary-adrenal (HPA) axis regulation. The review suggests that tVNS could serve as an effective strategy to modulate the BGM axis and potentially intervene in the progression or treatment of Alzheimer's disease in the future.
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Affiliation(s)
- Long Yan
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
- Graduate Department, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hong Li
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
- Graduate Department, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yulin Qian
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
| | - Junfeng Zhang
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
- Graduate Department, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shan Cong
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
- Graduate Department, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuemin Zhang
- Graduate Department, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Linna Wu
- Graduate Department, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yu Wang
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
| | - Meng Wang
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
| | - Tao Yu
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Acupuncture and Moxibustion, Tianjin, China
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The use of vestibular evoked myogenic potentials (VEMP) in the diagnosis of otolithic dysfunction of patients with obstructive sleep apnea: a survey of awareness and recognition of otorhinolaryngology medical staffs. Eur Arch Otorhinolaryngol 2023; 280:1603-1610. [PMID: 36030467 DOI: 10.1007/s00405-022-07616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess awareness and recognition of vestibular function tests in otorhinolaryngology medical staffs, especially the vestibular evoked myogenic potentials (VEMP) testing in patients with obstructive sleep apnea (OSA). METHODS A survey was delivered via either email or a social media app. The medical staffs of the Chinese Medical Association of Otolaryngology Head and Neck Surgery from various branches were enrolled. Study data were collected and managed with an online data collection tool. RESULTS A total of 1781 emails and 623 social media messages were sent to 2404 otorhinolaryngology medical staffs. One hundred and fifty-seven of them participated in the survey, including 24 via emails and 133 via the social media app. Regarding the knowledge of VEMP, only 59 (37.6%) of them agreed that OSA could be related to vertigo/dizziness/imbalance and 28 (17.8%) believed that OSA could result in VEMP abnormalities and would factor this in diagnosing the impairment of the vestibular function of OSA patients. A total of 7.6% of the respondents had never heard of the VEMP tests. Responses regarding the minimum age at which VEMP are possible ranged from younger than 6 months to greater than 18 years of age. Beliefs regarding the utility and reliability of VEMP varied, with 'unsure' being the most frequent response. In addition, only 17.8% of otolaryngologists indicated some access to the VEMP test. CONCLUSIONS Knowledge and beliefs about the role of VEMP in diagnosing otolithic organ dysfunction caused by OSA in otorhinolaryngology vary widely. It is important for otorhinolaryngology medical staffs to learn the latest literatures and updated knowledge through continuing education.
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Xu XD, Gao N, Yu J, Chen BJ, Chen ZC, Ren DD, Zhang Q, Fang R, Luo HP. The correlation between the body shape and otolithic function in patients with obstructive sleep apnea. Sleep Med 2022; 100:112-119. [PMID: 36041379 DOI: 10.1016/j.sleep.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/09/2022] [Accepted: 08/03/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify the typical pattern of changes of vestibular-evoked myogenic potentials (VEMPs) and explore the relationship between VEMPs and the anthropometry factors in patients with obstructive sleep apnea (OSA). METHODS Patients diagnosed as OSA after overnight polysomnography (PSG) tests were enrolled as the study group. Healthy volunteers were recruited as the control group. Anthropometry data of the body shape and VEMPs results were collected completely. The correlation analysis was conducted among those parameters. RESULTS Forty-nine patients with OSA who were diagnosed in the Therapy Center of Sleep-disordered Breathing in our hospital and sex- and age-matched healthy controls as well. Significant changes in ocular and cervical VEMPs (oVEMP and cVEMP) in the study group were observed, which were reduced response rates, elevated thresholds, decreased amplitudes, and prolonged first wave latencies. In oVEMP, the first wave (n1) latency was significantly correlated with weight, body mass index (BMI), neck circumference, waist circumference, hip circumference, and apnea hypopnea index (AHI). In a tentative application, combined use of BMI and oVEMP n1 latency increased the detection rate during OSA screening prior to PSG. CONCLUSION OSA can negatively affect function of otolithic organs and their pathways. The first wave latency of the VEMPs waveform may be another important parameter to define peripheral nervous system lesions caused by systemic diseases as OSA.
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Affiliation(s)
- Xin-Da Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Na Gao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Jing Yu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Bin-Jun Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Zi-Chen Chen
- Department of Otorhinolaryngology Head and Neck Surgery, XinHua Hospital, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Dong-Dong Ren
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Qing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, XinHua Hospital, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Rui Fang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; The Therapy Center of Sleep-disordered Breathing, Eye & ENT Hospital, Fudan University, Shanghai, 201112, China.
| | - Hui-Ping Luo
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; The Therapy Center of Sleep-disordered Breathing, Eye & ENT Hospital, Fudan University, Shanghai, 201112, China.
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Xu XD, Chen BJ, Sun AR, Zhang Q, Cheng Y, Ren DD, Yu J, Luo HP. Uneven Effects of Sleep Apnea on Semicircular Canals and Otolithic Organs. Front Neurol 2022; 13:819721. [PMID: 35250822 PMCID: PMC8888406 DOI: 10.3389/fneur.2022.819721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/12/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study aimed to explore how obstructive sleep apnea (OSA) affects the function of each vestibular organ and to identify the correlations among them. METHODS A prospective study was conducted involving 32 healthy controls and 64 patients with OSA. The objective detection methods of the utricle and saccule are vestibular-evoked myogenic potentials (VEMPs). A combination of the caloric test and video head impulse test (vHIT) was used to comprehensively evaluate the objective function of semicircular canals. RESULTS Elevated thresholds (p < 0.001), decreased waveform amplitudes (p < 0.001), prolonged first wave latencies (p < 0.001), and shortened first interpeak latencies (p < 0.001) were observed in both ocular VEMP (oVEMP) and cervical VEMP (cVEMP). A significant difference was found in the caloric test comparison (χ2 = 4.030, p = 0.045) but not in the vHIT. The intergroup comparison of normal rates among the VEMPs, caloric test, and vHIT groups showed a significant difference (p < 0.001). CONCLUSION The impairment of vestibular function in patients with OSA was uneven and biased. More attention should be given to vestibular dysfunction in the diagnosis and treatment of OSA.
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Affiliation(s)
- Xin-Da Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, China
| | - Bin-Jun Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, China
| | - An-Rong Sun
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Cheng
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiao Tong University School of Medicine, Xi'an, China
| | - Dong-Dong Ren
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, China
| | - Jing Yu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, China
| | - Hui-Ping Luo
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,The Therapy Center of Sleep-Disordered Breathing, Eye & ENT Hospital, Fudan University Shanghai, Shanghai, China
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Lee WJ, Sunwoo JS, Byun JI, Kim HJ, Lee ST, Jung KH, Park KI, Chu K, Kim M, Lee SK, Schenck CH, Jung KY. Isolated rapid eye movement sleep behavior disorder combined with obstructive sleep apnea: Response to treatment and its associated factors. Sleep Med 2022; 91:75-83. [DOI: 10.1016/j.sleep.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/04/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
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Luo HP, Yu J, Xu XD, Wang J, Zhang Q, Wu HT, Chi FL. Characteristic manifestation of ocular and cervical vestibular evoked myogenic potentials findings in severe obstructive sleep apnea patients. Acta Otolaryngol 2021; 141:754-761. [PMID: 34289321 DOI: 10.1080/00016489.2021.1947524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Studies of saccular and utricular function in patients with obstructive sleep apnea (OSA) are rare. We noticed that some OSA patients also had positive results in vestibular function tests, and this inspired our interest in exploring the vestibular function patterns of OSA patients. OBJECTIVES To investigate otolithic organ function in severe OSA patients who lack vestibular symptoms and systemic disease. MATERIAL AND METHODS 32 patients (64 ears) with severe OSA and 22 healthy controls (44 ears) were enrolled. The ocular and cervical vestibular-evoked myogenic potentials (oVEMP and cVEMP) and the caloric test were recorded and analyzed. RESULTS The response rates of oVEMP (73.4%) and cVEMP (82.8%) in patients with severe OSA were significantly lower than those in controls. In oVEMP, elevated thresholds (p = .002), decreased n1-p1 amplitudes (p < .001), prolonged n1 latencies (p < .001) were observed. In cVEMP, the elevation of thresholds (p < .001), decrease in p1-n1 amplitudes (p < .001), and n1-p2 amplitudes (p < .001), prolongation of p1 latencies (p = .003) were observed. No significant difference in the caloric test was found between the two groups. CONCLUSIONS AND SIGNIFICANCE Disappearance or impairment of VEMPs could be observed in patients with severe OSA, and reflects different degrees of impairment in the utricle and saccule.
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Affiliation(s)
- Hui-Ping Luo
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- The Therapy Center of Sleep-Disordered Breathing, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Yu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, China
| | - Xin-Da Xu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, China
| | - Jing Wang
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, XinHua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hai-Tao Wu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Fang-Lu Chi
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, China
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Deguchi K, Doi T, Takata T, Kokudo Y, Kobara H, Yamamoto M, Touge T, Masaki T. Rapid Eye Movement Sleep Behavior Disorder-like Symptoms Due to Arousal Responses Associated with Severe Obstructive Sleep Apnea-hypopnea. Intern Med 2021; 60:1775-1778. [PMID: 33431731 PMCID: PMC8222118 DOI: 10.2169/internalmedicine.6218-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 78-year-old man suspected of having α-synucleinopathies received a high score on a validated questionnaire for rapid eye movement (REM) sleep behavior disorder (RBD). Although he did in fact have unpleasant dreams and vigorous behaviors, polysomnography (PSG) found only obstructive sleep apnea-hypopnea (OSAH). The RBD-like symptoms corresponded with arousal responses, namely augmented inspiratory effort and leg movements, to his frequent apnea-hypopnea events during REM sleep. Thus, severe OSAH might cause RBD-like symptoms. PSG can discriminate real RBD from RBD-like symptoms associated with severe OSAH and therefore may be essential for determining an appropriate course of treatment in certain patients.
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Affiliation(s)
- Kazushi Deguchi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Tomokazu Doi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Tadayuki Takata
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Yohei Kokudo
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | | | - Tetsuo Touge
- Department of Health Sciences, Faculty of Medicine, Kagawa University, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
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Owen JE, Benediktsdottir B, Cook E, Olafsson I, Gislason T, Robinson SR. Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea. Sleep 2021; 44:5909379. [PMID: 32954401 DOI: 10.1093/sleep/zsaa195] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/10/2020] [Indexed: 12/23/2022] Open
Abstract
Obstructive sleep apnea (OSA) involves intermittent cessations of breathing during sleep. People with OSA can experience memory deficits and have reduced hippocampal volume; these features are also characteristic of Alzheimer's disease (AD), where they are accompanied by neurofibrillary tangles (NFTs) and amyloid beta (Aβ) plaques in the hippocampus and brainstem. We have recently shown reduced hippocampal volume to be related to OSA severity, and although OSA may be a risk factor for AD, the hippocampus and brainstems of clinically verified OSA cases have not yet been examined for NFTs and Aβ plaques. The present study used quantitative immunohistochemistry to investigate postmortem hippocampi of 34 people with OSA (18 females, 16 males; mean age 67 years) and brainstems of 24 people with OSA for the presence of NFTs and Aβ plaques. OSA severity was a significant predictor of Aβ plaque burden in the hippocampus after controlling for age, sex, body mass index (BMI), and continuous positive airway pressure (CPAP) use. OSA severity also predicted NFT burden in the hippocampus, but not after controlling for age. Although 71% of brainstems contained NFTs and 21% contained Aβ plaques, their burdens were not correlated with OSA severity. These results indicate that OSA accounts for some of the "cognitively normal" individuals who have been found to have substantial Aβ burdens, and are currently considered to be at a prodromal stage of AD.
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Affiliation(s)
- Jessica E Owen
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Bryndis Benediktsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Sleep Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elizabeth Cook
- Department of Clinical Biochemistry, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Sleep Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Stephen R Robinson
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria, Australia
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Birk R, Dietz M, Sommer JU, Stuck BA, Hörmann K, Rotter N, Maurer JT, Kramer B, Hülse R, Schell A. Nightly Hypoxia Does Not Seem to Lead to Otolith Dysfunction in Patients With Obstructive Sleep Apnea. EAR, NOSE & THROAT JOURNAL 2020; 100:667-672. [PMID: 32339052 DOI: 10.1177/0145561320922126] [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] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a common sleep disorder, which is associated with recurrent oxygen desaturation during sleep. It has already been shown that nocturnal hypoxia may lead to cochlear dysfunction in patients with OSA. Less is known whether hypoxia during sleep also impacts vestibular function in those patients. Thus, the aim of the presented study was to assess a potential vestibulotoxic effect of nightly desaturations with hypoxia in patients with OSA by investigating a possible correlation between respiratory parameters and vestibular function tests. METHODS A total of 56 patients were included in the study and underwent a fully attended cardiorespiratory polysomnography (PSG). Vestibular function was assessed using video head impulse test to evaluate horizontal semicircular canal function and cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potentials (oVEMPs) to measure otolith function. Descriptive data analysis was conducted and correlation analysis between selected PSG parameters and the results of vestibular testing was performed using Kendall τ coefficient. RESULTS A significant correlation between vestibular function and respiratory polysomnographic parameters could not be demonstrated in the study (P > .05) but cVEMP and oVEMP results showed a trend toward a correlation with oxygen desaturation indices and apnea-hypopnea index. Additionally, otolith hypofunction was more prevalent in patients with hypertension as well as OSA. CONCLUSION The results of our study show that there is no significant correlation between vestibular function and sleep apnea parameters, although otolith dysfunction might be more prevalent in patients with OSA and hypertension.
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Affiliation(s)
- Richard Birk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - Miriam Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - Jörg Ulrich Sommer
- Department of Otorhinolaryngology, Head and Neck Surgery, Helios University Clinic Wuppertal, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - Karl Hörmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - Joachim T Maurer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - Benedikt Kramer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - Roland Hülse
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - Angela Schell
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
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The relationship between the findings of vestibular evoked myogenic potentials and severity of obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2019; 277:37-46. [PMID: 31542832 DOI: 10.1007/s00405-019-05654-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Our study aimed to evaluate the effects of chronic hypoxic state in Obstructive Sleep Apnea Syndrome (OSAS) on brainstem pathways using Vestibular Evoked Myogenic Potential (VEMP) test and to investigate the presence of new markers likely to be correlated with the severity of the disease. METHODS The study was planned as prospective and double blind. A total of 60 patients (120 ears) diagnosed with mild, moderate and severe OSAS were included in the study and the patients are grouped as 20 patients in each group. Twenty volunteer healthy individuals (40 ears) shown to be without OSAS were included in the study. VEMP measurements were made in 60 study group patients (120 ears) and in 20 healthy controls (40 ears). The groups were compared in terms of variables such as the acquisition rate of oVEMP and cVEMP waves, interval between the waves, latency and amplitude of the waves. p < 0.05 values were considered as significant. RESULTS The results of cVEMP test showed that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the control group and mild OSAS groups (p = 0.008). There was no difference between the control group and the mild OSAS group in terms of the rate of obtaining the wave (p > 0.05). In the moderate and severe OSAS groups, P1N1 amplitude and N1P2 amplitude values were found to be significantly lower than the mild OSAS group (p = 0.007 and p = 0.017, respectively). In the oVEMP test, there was no significant difference between the mild OSAS group and the control group in terms of the wave yield (p > 0.05); however, it was found that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the mild OSAS group (p = 0.041). There was inverse correlation between the N1P2 interval and P1N1 amplitude value and AHI in simple regression analysis and multiple regression analysis (p = 0.012 and p = 0.021; p = 0.009 and p = 0.040, respectively). CONCLUSION The negative effects of chronic intermittent hypoxia related with OSAS on the brainstem and vestibular system can be demonstrated by VEMP tests. Especially, the inability to obtain the wave is the most important finding showing this situation. Also, we think that N1P2 interval and P1N1 amplitude markers can be used to detect the subclinical negative effect of chronic hypoxia on vestibular nuclei in the brainstem.
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Macheda T, Roberts K, Lyons DN, Higgins E, Ritter KJ, Lin AL, Alilain WJ, Bachstetter AD. Chronic Intermittent Hypoxia Induces Robust Astrogliosis in an Alzheimer's Disease-Relevant Mouse Model. Neuroscience 2018; 398:55-63. [PMID: 30529693 DOI: 10.1016/j.neuroscience.2018.11.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022]
Abstract
Sleep disturbances are a common early symptom of neurodegenerative diseases, including Alzheimer's disease (AD) and other age-related dementias, and emerging evidence suggests that poor sleep may be an important contributor to development of amyloid pathology. Of the causes of sleep disturbances, it is estimated that 10-20% of adults in the United States have sleep-disordered breathing (SDB) disorder, with obstructive sleep apnea accounting for the majority of the SBD cases. The clinical and epidemiological data clearly support a link between sleep apnea and AD; yet, almost no experimental research is available exploring the mechanisms associated with this correlative link. Therefore, we exposed an AD-relevant mouse model (APP/PS1 KI) to chronic intermittent hypoxia (IH) (an experimental model of sleep apnea) to begin to describe one of the potential mechanisms by which SDB could increase the risk of dementia. Previous studies have found that astrogliosis is a contributor to neuropathology in models of chronic IH and AD; therefore, we hypothesized that a reactive astrocyte response might be a contributing mechanism in the neuroinflammation associated with sleep apnea. To test this hypothesis, 10-11-month-old wild-type (WT) and APP/PS1 KI mice were exposed to 10 hours of IH, daily for four weeks. At the end of four weeks brains were analyzed from amyloid burden and astrogliosis. No effect was found for chronic IH exposure on amyloid-beta levels or plaque load in the APP/PS1 KI mice. A significant increase in GFAP staining was found in the APP/PS1 KI mice following chronic IH exposure, but not in the WT mice. Profiling of genes associated with different phenotypes of astrocyte activation identified GFAP, CXCL10, and Ggta1 as significant responses activated in the APP/PS1 KI mice exposed to chronic IH.
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Affiliation(s)
- Teresa Macheda
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, United States; Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Kelly Roberts
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, United States; Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Danielle N Lyons
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, United States; Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Emma Higgins
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, United States; Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Kyle J Ritter
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, United States; Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Ai-Ling Lin
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, United States; Department of Nutrition and Pharmacology, University of Kentucky, Lexington, KY, United States
| | - Warren J Alilain
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, United States; Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Adam D Bachstetter
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, United States; Department of Neuroscience, University of Kentucky, Lexington, KY, United States.
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Lu HY, Wang W, Zhou Z, Liu CY, Liu Y, Xiao W, Dong FS, Wang J. Treatment of obstructive sleep apnoea–hypopnea syndrome by mandible advanced device reduced neuron apoptosis in frontal cortex of rabbits. Eur J Orthod 2017; 40:273-280. [DOI: 10.1093/ejo/cjx060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Hai-yan Lu
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Wen Wang
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Zheng Zhou
- Department of Periodontology, University of Detroit Mercy, Detroit, MI, USA
| | - Chun-yan Liu
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Ye Liu
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Wei Xiao
- Department of Stomatology, FengTai Hospital, Beijing, P.R. of China
| | - Fu-sheng Dong
- Department of Oral and Maxillofacial Surgery, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Jie Wang
- Department of Oral Pathology, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
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13
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Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res 2015; 93:1778-94. [DOI: 10.1002/jnr.23634] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE/Melbourne School of Engineering, The University of Melbourne; Parkville Victoria Australia
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Lucke-Wold BP, Smith KE, Nguyen L, Turner RC, Logsdon AF, Jackson GJ, Huber JD, Rosen CL, Miller DB. Sleep disruption and the sequelae associated with traumatic brain injury. Neurosci Biobehav Rev 2015; 55:68-77. [PMID: 25956251 PMCID: PMC4721255 DOI: 10.1016/j.neubiorev.2015.04.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/17/2015] [Accepted: 04/25/2015] [Indexed: 02/08/2023]
Abstract
Sleep disruption, which includes a loss of sleep as well as poor quality fragmented sleep, frequently follows traumatic brain injury (TBI) impacting a large number of patients each year in the United States. Fragmented and/or disrupted sleep can worsen neuropsychiatric, behavioral, and physical symptoms of TBI. Additionally, sleep disruption impairs recovery and can lead to cognitive decline. The most common sleep disruption following TBI is insomnia, which is difficulty staying asleep. The consequences of disrupted sleep following injury range from deranged metabolomics and blood brain barrier compromise to altered neuroplasticity and degeneration. There are several theories for why sleep is necessary (e.g., glymphatic clearance and metabolic regulation) and these may help explain how sleep disruption contributes to degeneration within the brain. Experimental data indicate disrupted sleep allows hyperphosphorylated tau and amyloid β plaques to accumulate. As sleep disruption may act as a cellular stressor, target areas warranting further scientific investigation include the increase in endoplasmic reticulum and oxidative stress following acute periods of sleep deprivation. Potential treatment options for restoring the normal sleep cycle include melatonin derivatives and cognitive behavioral therapy.
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Affiliation(s)
- Brandon P Lucke-Wold
- The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA; Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Kelly E Smith
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV 26506, USA; The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV 26506, USA; The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Ryan C Turner
- The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA; Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Aric F Logsdon
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV 26506, USA; The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Garrett J Jackson
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Jason D Huber
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV 26506, USA; The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Charles L Rosen
- The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA; Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Diane B Miller
- The Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, USA; Centers for Disease Control and Prevention-National Institute for Occupational Safety and Health, Morgantown, WV, USA.
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Daulatzai MA. “Boomerang Neuropathology” of Late-Onset Alzheimer’s Disease is Shrouded in Harmful “BDDS”: Breathing, Diet, Drinking, and Sleep During Aging. Neurotox Res 2015; 28:55-93. [DOI: 10.1007/s12640-015-9528-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 12/12/2022]
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16
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Gelber RP, Redline S, Ross GW, Petrovitch H, Sonnen JA, Zarow C, Uyehara-Lock JH, Masaki KH, Launer LJ, White LR. Associations of brain lesions at autopsy with polysomnography features before death. Neurology 2014; 84:296-303. [PMID: 25503626 DOI: 10.1212/wnl.0000000000001163] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine how sleep-disordered breathing, nocturnal hypoxia, and changes in sleep architecture in the elderly may be related to the development of the neuropathologic correlates of dementia. METHODS The Honolulu-Asia Aging Study is a prospective cohort study of Japanese American men in Honolulu, HI. We examined brain lesions at autopsy (Braak stage, neurofibrillary tangle and neuritic plaque counts, microinfarcts, generalized brain atrophy, lacunar infarcts, Lewy bodies [LBs], neuronal loss and gliosis in the locus ceruleus) in 167 participants who underwent polysomnography in 1999-2000 (mean age, 84 years) and died through 2010 (mean 6.4 years to death). Polysomnography measures included the apnea-hypopnea index, duration of apnea or hypopnea, duration of hypoxemia, minimum oxygen saturation (SpO₂), duration of slow-wave sleep (SWS, non-REM stage N3), and arousals. RESULTS Sleep duration with SpO₂ <95% was associated with higher levels of microinfarcts (adjusted odds ratio [OR] 3.88, 95% confidence interval [CI] 1.10-13.76, comparing the highest to lowest quartiles of %sleep with SpO₂ <95%). Greater SWS duration was associated with less generalized atrophy (adjusted OR 0.32, 95% CI 0.10-1.03, comparing highest to lowest quartiles of %sleep in SWS). LBs were less common with greater %sleep with SpO₂ <95% (adjusted OR 0.17, 95% CI 0.04-0.78, comparing highest to lowest quartiles). Higher minimum SpO₂ during REM sleep was associated with less gliosis and neuronal loss in the locus ceruleus. Cognitive scores declined less among men with greater SWS duration. CONCLUSIONS The findings support a role for lower nocturnal oxygenation and SWS in the development of microinfarcts and brain atrophy, but not Alzheimer lesions or LBs.
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Affiliation(s)
- Rebecca P Gelber
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD.
| | - Susan Redline
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - G Webster Ross
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - Helen Petrovitch
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - Joshua A Sonnen
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - Chris Zarow
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - Jane H Uyehara-Lock
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - Kamal H Masaki
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - Lenore J Launer
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
| | - Lon R White
- From the VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.), Pacific Health Research and Education Institute (R.P.G., G.W.R., H.P., J.H.U.-L., L.R.W.), Departments of Medicine (G.W.R., H.P.), Geriatric Medicine (G.W.R., H.P., K.H.M., L.R.W.), and Pathology (J.H.U.-L.), University of Hawaii John A. Burns School of Medicine, and Kuakini Medical Center (K.H.M.), Honolulu, HI; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Departments of Medicine and Neurology, Brigham and Women's Hospital (S.R.), Department of Medicine, Beth Israel Deaconess Medical Center (S.R.), and Harvard Medical School (S.R.), Boston, MA; and the Laboratory of Epidemiology and Population Sciences (L.J.L., L.R.W.), Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD
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Swartz EM, Holmes GM. Gastric vagal motoneuron function is maintained following experimental spinal cord injury. Neurogastroenterol Motil 2014; 26:1717-29. [PMID: 25316513 PMCID: PMC4245370 DOI: 10.1111/nmo.12452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/13/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clinical reports indicate that spinal cord injury (SCI) initiates profound gastric dysfunction. Gastric reflexes involve stimulation of sensory vagal fibers, which engage brainstem circuits that modulate efferent output back to the stomach, thereby completing the vago-vagal reflex. Our recent studies in a rodent model of experimental high thoracic (T3-) SCI suggest that reduced vagal afferent sensitivity to gastrointestinal (GI) stimuli may be responsible for diminished gastric function. Nevertheless, derangements in efferent signals from the dorsal motor nucleus of the vagus (DMV) to the stomach may also account for reduced motility. METHODS We assessed the anatomical, neurophysiological, and functional integrity of gastric-projecting DMV neurons in T3-SCI rats using: (i) retrograde labeling of gastric-projecting DMV neurons; (ii) whole cell recordings from gastric-projecting neurons of the DMV; and, (iii) in vivo measurements of gastric contractions following unilateral microinjection of thyrotropin-releasing hormone (TRH) into the DMV. KEY RESULTS Immunohistochemical analysis of gastric-projecting DMV neurons demonstrated no difference between control and T3-SCI rats. Whole cell in vitro recordings showed no alteration in DMV membrane properties and the neuronal morphology of these same, neurobiotin-labeled, DMV neurons were unchanged after T3-SCI with regard to cell size and dendritic arborization. Central microinjection of TRH induced a significant facilitation of gastric contractions in both control and T3-SCI rats and there were no significant dose-dependent differences between groups. CONCLUSIONS & INFERENCES Our data suggest that the acute, 3 day to 1 week post-SCI, dysfunction of vagally mediated gastric reflexes do not include derangements in the efferent DMV motoneurons.
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Affiliation(s)
| | - Gregory M. Holmes
- Corresponding author: Dr. Gregory M. Holmes, Department of Neural and Behavioral Sciences, Penn State College of Medicine, 500 University Drive, MC H109, Hershey, PA 17033,
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18
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Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2014; 272:3137-41. [DOI: 10.1007/s00405-014-3294-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023]
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Paltsyn AA, Manukhina EB, Goryacheva AV, Downey HF, Dubrovin IP, Komissarova SV, Kubatiev AA. Intermittent hypoxia stimulates formation of binuclear neurons in brain cortex—A role of cell fusion in neuroprotection? Exp Biol Med (Maywood) 2014; 239:595-600. [DOI: 10.1177/1535370214523898] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Oligodendrocyte fusion with neurons in the brain cortex is a part of normal ontogenesis and is a possible means of neuroregeneration. Following such fusion, the oligodendrocyte nucleus undergoes neuron-specific reprogramming, resulting in the formation of binuclear neurons, which doubles the functional capability of the neuron. In this study, we tested the hypothesis that the formation of binuclear neurons is involved in long-term adaptation of the brain to intermittent hypobaric hypoxia, which is known to be neuroprotective. Rats were adapted to hypoxia in an altitude chamber at a simulated altitude of 4000 m above sea level for 14 days (30 min increasing to 4 h, daily). One micrometer sections of the left motor cortex were analyzed by light microscopy. Phases of the fusion and reprogramming process were recorded, and the number of binuclear neurons was counted for all section areas containing pyramidal neurons of layers III–V. For the control group subjected to sham hypoxia, the density of binuclear neurons was 4.49 ± 0.32 mm2. In the hypoxia-adapted group, this density increased to 5.71 ± 0.39 mm2 ( P < 0.04). In a subgroup of rats exposed to only one hypoxia session, the number of binuclear neurons did not differ from the number observed in the control group. We suggest that the increased content of binuclear neurons may serve as a structural basis for the neuroprotective effects of the adaptation to hypoxia.
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Affiliation(s)
- Alexander A Paltsyn
- Institute of General Pathology and Pathophysiology, Moscow 125315, Russia
- Russian Medical Academy of Postgraduate Education, Moscow 125315, Russia
| | - Eugenia B Manukhina
- Institute of General Pathology and Pathophysiology, Moscow 125315, Russia
- University of North Texas Health Science Center, Fort Worth, Texas 76107, USA
| | - Anna V Goryacheva
- Institute of General Pathology and Pathophysiology, Moscow 125315, Russia
| | - H Fred Downey
- University of North Texas Health Science Center, Fort Worth, Texas 76107, USA
| | - Ivan P Dubrovin
- Institute of General Pathology and Pathophysiology, Moscow 125315, Russia
| | | | - Aslan A Kubatiev
- Institute of General Pathology and Pathophysiology, Moscow 125315, Russia
- Russian Medical Academy of Postgraduate Education, Moscow 125315, Russia
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Lima AMA, de Bruin VMS, Rios ERV, de Bruin PFC. Differential effects of paradoxical sleep deprivation on memory and oxidative stress. Naunyn Schmiedebergs Arch Pharmacol 2014; 387:399-406. [PMID: 24424716 DOI: 10.1007/s00210-013-0955-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 12/25/2013] [Indexed: 02/06/2023]
Abstract
Sleep has important functions for every organ in the body and sleep deprivation (SD) leads to disorders that cause irreparable damage. The aim of this study was to investigate behavioral and brain structural alterations in mice deprived of paradoxical sleep for 48 and 72 h. Working memory, aversive memory as well as levels of nitric oxide (NO) and thiobarbituric acid reactive substances (TBARS) in the hippocampus, body striatum, and prefrontal cortex were evaluated. Working memory was affected in the 48- and 72-h SD groups while aversive memory was altered only in the 48-h SD group (p ≤ 0.05). Our findings showed that SD reduces NO levels in most brain areas (p < 0.05): NO levels were unaltered in the striatum of animals sleep-deprived for 48 h. Higher levels of TBARS were observed in all areas of the SD groups (p ≤ 0.05). Thus, we confirmed that SD has duration-dependent effects on behavior as well as on NO and TBARS levels in the brain. Preserved striatum NO levels suggest that this structure is less vulnerable to oxidative stress and is only affected by SD of longer duration. Increased TBARS and reduced NO levels in the hippocampus and prefrontal cortex confirm a central role for both these structures in working memory and aversive memory. Contextual fear conditioning was not affected by longer periods of SD. Thus, our findings suggest that shorter SD time may be more beneficial to avoid aversive memory where this may have implications for the management of posttraumatic stress.
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Affiliation(s)
- Alisson Menezes Araujo Lima
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, R. Cel Nunes de Melo 1315, Rodolfo Teófilo, 60.430-270, Fortaleza, Ceará, Brazil
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21
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Li Y, Panossian LA, Zhang J, Zhu Y, Zhan G, Chou YT, Fenik P, Bhatnagar S, Piel DA, Beck SG, Veasey S. Effects of chronic sleep fragmentation on wake-active neurons and the hypercapnic arousal response. Sleep 2014; 37:51-64. [PMID: 24470695 DOI: 10.5665/sleep.3306] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Delayed hypercapnic arousals may occur in obstructive sleep apnea. The impaired arousal response is expected to promote more pronounced oxyhemoglobin desaturations. We hypothesized that long-term sleep fragmentation (SF) results in injury to or dysfunction of wake-active neurons that manifests, in part, as a delayed hypercapnic arousal response. DESIGN Adult male mice were implanted for behavioral state recordings and randomly assigned to 4 weeks of either orbital platform SF (SF4wk, 30 events/h) or control conditions (Ct4wk) prior to behavioral, histological, and locus coeruleus (LC) whole cell electrophysiological evaluations. MEASUREMENTS AND RESULTS SF was successfully achieved across the 4 week study, as evidenced by a persistently increased arousal index, P < 0.01 and shortened sleep bouts, P < 0.05, while total sleep/wake times and plasma corticosterone levels were unaffected. A multiple sleep latency test performed at the onset of the dark period showed a reduced latency to sleep in SF4wk mice (P < 0.05). The hypercapnic arousal latency was increased, Ct4wk 64 ± 5 sec vs. SF4wk 154 ± 6 sec, P < 0.001, and remained elevated after a 2 week recovery (101 ± 4 sec, P < 0.001). C-fos activation in noradrenergic, orexinergic, histaminergic, and cholinergic wake-active neurons was reduced in response to hypercapnia (P < 0.05-0.001). Catecholaminergic and orexinergic projections into the cingulate cortex were also reduced in SF4wk (P < 0.01). In addition, SF4wk resulted in impaired LC neuron excitability (P < 0.01). CONCLUSIONS Four weeks of sleep fragmentation (SF4wk) impairs arousal responses to hypercapnia, reduces wake neuron projections and locus coeruleus neuronal excitability, supporting the concepts that some effects of sleep fragmentation may contribute to impaired arousal responses in sleep apnea, which may not reverse immediately with therapy.
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Affiliation(s)
- Yanpeng Li
- Department of Neurology, Neuroscience Research Center, Shanghai Changzheng Hospital, the Affiliated Hospital to the Second Military Medical University, Shanghai City, China ; Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lori A Panossian
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jing Zhang
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Yan Zhu
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Guanxia Zhan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Yu-Ting Chou
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Polina Fenik
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Seema Bhatnagar
- Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David A Piel
- Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sheryl G Beck
- Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sigrid Veasey
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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22
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Death by a thousand cuts in Alzheimer's disease: hypoxia--the prodrome. Neurotox Res 2013; 24:216-43. [PMID: 23400634 DOI: 10.1007/s12640-013-9379-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/10/2013] [Accepted: 01/21/2013] [Indexed: 12/30/2022]
Abstract
A wide range of clinical consequences may be associated with obstructive sleep apnea (OSA) including systemic hypertension, cardiovascular disease, pulmonary hypertension, congestive heart failure, cerebrovascular disease, glucose intolerance, impotence, gastroesophageal reflux, and obesity, to name a few. Despite this, 82 % of men and 93 % of women with OSA remain undiagnosed. OSA affects many body systems, and induces major alterations in metabolic, autonomic, and cerebral functions. Typically, OSA is characterized by recurrent chronic intermittent hypoxia (CIH), hypercapnia, hypoventilation, sleep fragmentation, peripheral and central inflammation, cerebral hypoperfusion, and cerebral glucose hypometabolism. Upregulation of oxidative stress in OSA plays an important pathogenic role in the milieu of hypoxia-induced cerebral and cardiovascular dysfunctions. Strong evidence underscores that cerebral amyloidogenesis and tau phosphorylation--two cardinal features of Alzheimer's disease (AD), are triggered by hypoxia. Mice subjected to hypoxic conditions unambiguously demonstrated upregulation in cerebral amyloid plaque formation and tau phosphorylation, as well as memory deficit. Hypoxia triggers neuronal degeneration and axonal dysfunction in both cortex and brainstem. Consequently, neurocognitive impairment in apneic/hypoxic patients is attributable to a complex interplay between CIH and stimulation of several pathological trajectories. The framework presented here helps delineate the emergence and progression of cognitive decline, and may yield insight into AD neuropathogenesis. The global impact of CIH should provide a strong rationale for treating OSA and snoring clinically, in order to ameliorate neurocognitive impairment in aged/AD patients.
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The dorsal motor nucleus of the vagus (DMNV) in sudden infant death syndrome (SIDS): pathways leading to apoptosis. Respir Physiol Neurobiol 2012; 185:203-10. [PMID: 22975482 DOI: 10.1016/j.resp.2012.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/08/2012] [Accepted: 09/04/2012] [Indexed: 12/20/2022]
Abstract
Sudden infant death syndrome (SIDS) remains the commonest cause of death in the post-neonatal period in the developed world. A leading hypothesis is that an abnormality in the brainstem of infants who succumb to SIDS, either causes or predisposes to failure to respond appropriately to an exogenous stressor. Neuronal apoptosis can lead to loss of cardiorespiratory reflexes, compromise of the infant's ability to respond to stressors such as hypoxia, and ultimately a sleep-related death. The dorsal motor nucleus of the vagus (DMNV) is a medullary autonomic nucleus where abnormalities have regularly been identified in SIDS research. This review collates neurochemical findings documented over the last 30 years, including data from our laboratory focusing on neuronal apoptosis and the DMNV, and provides potential therapeutic interventions targeting neurotransmitters, growth factors and/or genes.
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Fung SJ, Xi M, Zhang J, Sampogna S, Chase MH. Apnea produces excitotoxic hippocampal synapses and neuronal apoptosis. Exp Neurol 2012; 238:107-13. [PMID: 22921462 DOI: 10.1016/j.expneurol.2012.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/27/2012] [Accepted: 08/03/2012] [Indexed: 12/20/2022]
Abstract
Obstructive sleep apnea (OSA) results in the degeneration of neurons in the hippocampus that eventuates in neurocognitive deficits. We were therefore interested in determining the effects of apnea on monosynaptic excitatory processes in a hippocampal pathway (cornu ammonis 3-cornu ammonis 1, CA3-CA1) that has been shown to mediate the processing of cognitive information. In addition, to substantiate an anatomical basis for the cognitive dysfunction that occurs in OSA patients, we examined the effects of apnea with respect to neurodegenerative changes (apoptosis) in the same hippocampal pathway. In order to determine the effects of apnea, an automated system for the generation and analysis of single and recurrent periods of apnea was developed. Utilizing this system, the field excitatory postsynaptic potential (fEPSP) generated by pyramidal neurons in the CA1 region of the hippocampus was monitored in α-chloralose anesthetized rats following stimulation of glutamatergic afferents in the CA3 region. A stimulus-response (input-output) curve for CA3-CA1 synaptic activity was determined. In addition, a paired-pulse paradigm was employed to evaluate, electrophysiologically, the presynaptic release of glutamate. Changes in the synaptic efficacy were assessed following single episodes of apnea induced by ventilatory arrest (60 to 80 s duration, mean=72 s; mean oxygen desaturation was 53% of normoxia level). Apnea resulted in a significant potentiation of the amplitude (mean=126%) and slope (mean=117%) of the baseline CA1 fEPSP. This increase in the fEPSP was accompanied by a significant decrease in the amplitude (71%) and slope (81%) of normalized paired-pulse facilitation (PPF) ratios. Since the potentiation of the fEPSP is inversely proportional to changes in PPF ratio, the potentiated fEPSP accompanied by the reduced PPF reveals that apnea produces an abnormal increase in the preterminal release of glutamate that results in the over-activation (and calcium overloading) of hippocampal CA1 neurons. Thus, we conclude that individual episodes of apnea result in the development of excitotoxic processes in the hippocampal CA3-CA1 pathway that is critically involved in the processing of cognitive information. Morphologically, the deleterious effect of recurrent apnea was substantiated by the finding of apoptosis in CA1 neurons of apneic (but not normoxic) animals.
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Affiliation(s)
- Simon J Fung
- VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
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25
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Quintessential Risk Factors: Their Role in Promoting Cognitive Dysfunction and Alzheimer’s Disease. Neurochem Res 2012; 37:2627-58. [DOI: 10.1007/s11064-012-0854-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 07/21/2012] [Indexed: 12/13/2022]
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Kumar R, Chavez AS, Macey PM, Woo MA, Yan-Go FL, Harper RM. Altered global and regional brain mean diffusivity in patients with obstructive sleep apnea. J Neurosci Res 2012; 90:2043-52. [PMID: 22715089 DOI: 10.1002/jnr.23083] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/27/2012] [Accepted: 04/13/2012] [Indexed: 12/30/2022]
Abstract
Obstructive sleep apnea (OSA) is a common and progressive disorder accompanied by severe cardiovascular and neuropsychological sequelae, presumably induced by brain injury resulting from the intermittent hypoxia and cardiovascular processes accompanying the syndrome. However, whether the predominant brain tissue pathology is acute or chronic in newly-diagnosed, untreated OSA subjects is unclear; this assessment is essential for revealing pathological processes. Diffusion tensor imaging (DTI)-based mean diffusivity (MD) procedures can detect and differentiate acute from chronic pathology and may be useful to reveal processes in the condition. We collected four DTI series from 23 newly-diagnosed, treatment-naïve OSA and 23 control subjects, using a 3.0-Tesla magnetic resonance imaging scanner. Mean diffusivity maps were calculated from each series, realigned, averaged, normalized to a common space, and smoothed. Global brain MD values for each subject were calculated using normalized MD maps and a global brain mask. Mean global brain MD values and smoothed MD maps were compared between groups by using analysis of covariance (covariate: age). Mean global brain MD values were significantly reduced in OSA compared with controls (P = 0.01). Multiple brain sites in OSA, including medullary, cerebellar, basal ganglia, prefrontal and frontal, limbic, insular, cingulum bundle, external capsule, corpus callosum, temporal, occipital, and corona radiata regions showed reduced regional MD values compared with controls. The results suggest that global brain MD values are significantly reduced in OSA, with certain regional sites especially affected, presumably a consequence of axonal, glial, and other cell changes in those areas. The findings likely represent acute pathological processes in newly-diagnosed OSA subjects.
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Affiliation(s)
- Rajesh Kumar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California, USA
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Dysfunctional nucleus tractus solitarius: its crucial role in promoting neuropathogenetic cascade of Alzheimer's dementia--a novel hypothesis. Neurochem Res 2012; 37:846-68. [PMID: 22219130 DOI: 10.1007/s11064-011-0680-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/16/2011] [Accepted: 12/15/2011] [Indexed: 12/22/2022]
Abstract
The pathophysiological mechanism(s) underlying Alzheimer's disease (AD) still remain unclear, and no disease-modifying or prophylactic therapies are currently available. Unraveling the fundamental neuropathogenesis of AD is an important challenge. Several studies on AD have suggested lesions in a number of CNS areas including the basal forebrain, hippocampus, entorhinal cortex, amygdale/insula, and the locus coeruleus. However, plausible unifying studies on the upstream factors that involve these heterogeneous regions and herald the onset of AD pathogenesis are not available. The current article presents a novel nucleus tractus solitarius (NTS) vector hypothesis that underpins several disparate biological mechanisms and neural circuits, and identifies relevant hallmarks of major presumptive causative factor(s) linked to the NTS, in older/aging individuals. Aging, obesity, infection, sleep apnea, smoking, neuropsychological states, and hypothermia-all activate inflammatory cytokines and oxidative stress. The synergistic impact of systemic proinflammatory mediators activates microglia and promotes neuroinflammation. Acutely, the innate immune response is protective defending against pathogens/toxins; however, when chronic, it causes neuroinflammation and neuronal dysfunction, particularly in brainstem and neocortex. The NTS in the brainstem is an essential multiple signaling hub, and an extremely important central integration site of baroreceptor, chemoreceptor, and a multitude of sensory afferents from gustatory, gastrointestinal, cardiac, pulmonary, and upper airway systems. Owing to persistent neuroinflammation, the dysfunctional NTS exerts deleterious impact on nucleus ambiguus, dorsal motor nucleus of vagus, hypoglossal, parabrachial, locus coeruleus and many key nuclei in the brainstem, and the hippocampus, entorhinal cortex, prefrontal cortex, amygdala, insula, and basal forebrain in the neocortex. The neuronal and synaptic dysfunction emanating from the inflamed NTS may affect its interconnected pathways impacting almost the entire CNS--which is already primed by neuroinflammation, thus promoting cognitive and neuropsychiatric symptoms. The upstream factors discussed here may underpin the neuropathopgenesis of AD. AD pathology is multifactorial; the current perspective underscores the value of attenuating disparate upstream factors--in conjunction with anticholinesterase, anti-inflammatory, immunosuppressive, and anti-oxidant pharmacotherapy. Amelioration of the NTS pathology may be of central importance in countering the neuropathological cascade of AD. The NTS, therefore, may be a potential target of novel therapeutic strategies.
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Chronic Intermittent Hypoxia Increases Apnoea Index in Sleeping Rats. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 758:359-63. [DOI: 10.1007/978-94-007-4584-1_48] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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