Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation

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

doi:10.1007/s11906-014-0476-2

Cited by 112Obstructive Sleep Apnea ResearchNeuroscience of respiration and sleepHeart Rate Variability and Autonomic Control

Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation

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Mansukhani, Meghna P., Kara, Tomas, Caples, Sean M., Somers, Virend K.·2014·Current Hypertension Reports

DOI 10.1007/s11906-014-0476-2PMC PMC4249628

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Abstract

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

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Obesity hypertension is frequently associated with obstructive sleep apnoea, intermittent nocturnal hypoxia and elevated sympathetic nerve activity.
“Obesity hypertension is frequently associated with OSA, intermittent nocturnal hypoxia and elevated SNA174,182.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [182]
Obesity is associated with a heightened central chemoreflex response to hypercapnia in the absence of coexisting disease.
“Obesity is also associated with a heightened central chemoreflex response to hypercapnia in the absence of coexisting disease182,183.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [182]
Sympathetic dysregulation during hypoxia occurs in patients with obstructive sleep apnoea but is generally not seen in healthy individuals with voluntary apnoea.
“Although sympathetic dysregulation during hypoxia occurs in patients with OSA, this effect is generally not seen in healthy individuals with voluntary apnoea182.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [182]
Chemoreflex-induced sympathetic responses to hypoxia are exaggerated in patients with obesity and obstructive sleep apnoea compared with individuals without obesity exposed to hypoxia.
“Chemoreflex-induced sympathetic responses to hypoxia are exaggerated in patients with obesity and OSA compared with individuals without obesity exposed to hypoxia182,183.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [182]

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Obesity, kidney dysfunction and hypertension: mechanistic links
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Authors: Mansukhani, M. P., Kara, T., Caples, S. M., & Somers, V. K.
Affiliations: Mayo Clinic (US)
Corresponding author: Mansukhani, Meghna P.
ORCID: Mansukhani, Meghna P.
Somers, Virend K.
Venue: Current Hypertension Reports
Publisher: Springer Science and Business Media LLC
Published: 2014-08-06
Volume: 16
Issue: 9
Pages: 476-476
ISSN: 1522-6417 (ISSN-L)
1534-3111
DOI: 10.1007/s11906-014-0476-2
PMC: PMC4249628
OpenAlex: W2025517143
Cited by: 112
References: 187
Citations by year: 2026: 4 · 2025: 6 · 2024: 12 · 2023: 8 · 2022: 11 · 2021: 11 · 2020: 12 · 2019: 9 · 2018: 9 · 2017: 8 · 2016: 12 · 2015: 7 · 2014: 2 · 2013: 1
FWCI: 1.13
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
Locations: Current Hypertension Reports (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Heart, Lung, and Blood Institute (R01HL065176)
Topics: Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords: obstructive sleep apnea, chemoreflex, peripheral chemoreceptors, sympathetic nervous system, hypertension, hypoxemia, autonomic imbalance, cardiovascular variability, obesity, metabolic syndrome, sleep-disordered breathing, apnea
MeSH terms: Autonomic Nervous System Diseases, Blood Pressure, Chemoreceptor Cells, Humans, Reflex, Sleep, Sympathetic Nervous System, Sleep Apnea, Obstructive

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Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation

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