Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea
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Abstract Obstructive sleep apnoea (OSA) is common in the general population and increases the risk of motor vehicle accidents due to hypersomnolence from sleep disruption, and risk of cardiovascular diseases owing to repetitive hypoxia, sympathetic nervous system activation, and systemic inflammation. In contrast, central sleep apnoea (CSA) is rare in the general population. Although their pathogenesis is multifactorial, the prevalence of both OSA and CSA is increased in patients with fluid retaining states, especially heart failure, where they are associated with increased mortality risk. This observation suggests that fluid retention may contribute to the pathogenesis of both OSA and CSA. According to this hypothesis, during the day fluid accumulates in the intravascular and interstitial spaces of the legs due to gravity, and upon lying down at night redistributes rostrally, again owing to gravity. Some of this fluid may accumulate in the neck, increasing tissue pressure and causing the upper airway to narrow, thereby increasing its collapsibility and predisposing to OSA. In heart failure patients, with increased rostral fluid shift, fluid may additionally accumulate in the lungs, provoking hyperventilation and hypocapnia, driving below the apnoea threshold, leading to CSA. This review article will explore mechanisms by which overnight rostral fluid shift, and its prevention, can contribute to the pathogenesis and therapy of sleep apnoea.
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Fluid accumulation in patients with congestive heart failure and end-stage renal failure predisposes to obstructive sleep apnea by nocturnal redistribution of fluid in the recumbent position to the parapharyngeal soft tissues, which increases upper airway resistance and collapsibility.
“Fluid accumulation in patients with congestive heart failure (CHF) and end‐stage renal failure, predisposes to OSA by nocturnal redistribution of fluid in the recumbent position to the parapharyngeal soft tissues, which increases upper airway resistance and collapsibility (Lyons et al., 2017; White & Bradley, 2013).”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as White & Bradley, 2013
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“The prevalence of sleep apnoea is much higher in patients with fluid-retaining states such as heart failure and end-stage renal disease (ESRD) than in the general population (Young et al. 1993; Jurado-Gamez et al. 2007; Yumino et al. 2009).”
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- Authors
- White, L. H., & Bradley, T. D.
- Affiliations
- University Health Network (CA)
- Corresponding author
- Bradley, T. Douglas
- Venue
- The Journal of Physiology
- Publisher
- Wiley
- Published
- 2013-01-23
- Volume
- 591
- Issue
- 5
- Pages
- 1179-1193
- ISSN
- 0022-3751 (ISSN-L)
- 1469-7793
- PMC
- PMC3607865
- OpenAlex
- W1520388755
- Cited by
- 348
- References
- 7
- Citations by year
- 2026: 22 · 2025: 31 · 2024: 30 · 2023: 25 · 2022: 25 · 2021: 33 · 2020: 18 · 2019: 24 · 2018: 28 · 2017: 23 · 2016: 37 · 2015: 29 · 2014: 13 · 2013: 9
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Physiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (MOP82731)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Health Sciences › Medicine › Pharmacology › Apelin-related biomedical research
- Keywords
- obstructive sleep apnea, central sleep apnea, fluid retention, heart failure, upper airway collapsibility, hypocapnia, hyperventilation, pathogenesis
- MeSH terms
- Animals, Circadian Rhythm, Edema, Gravitation, Hemodynamics, Humans, Lung, Posture, Pressure, Risk Factors, Sleep, Water-Electrolyte Balance, Water-Electrolyte Imbalance, Sleep Apnea, Obstructive, Sleep Apnea, Central, Sedentary Behavior
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