The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index.
Stable breathing through deeper sleeping
Open accessAbstract
Although there is evidence that patients with obstructive sleep apnoea (OSA) have anatomical susceptibility coupled with abnormalities in upper airway motor control and/or instability in ventilatory control, the data now suggest that the mechanisms underlying OSA vary considerably between patients.1 In some patients OSA is primarily the result of anatomical problems, while in others it may be due to dysfunctional motor control with only minimal anatomical abnormality. Similarly, abnormal ventilatory control (loop gain) may be important in only a subgroup of patients with OSA.2 As a result, the concept of individualised therapy has now emerged, such that treatment of the major underlying abnormality is likely to be beneficial in the appropriately targeted patient subgroups.3 In theory, patients with OSA who respond well to palatal surgery probably primarily have an abnormality in the velopharyngeal anatomy,4 whereas those who respond well to oxygen may have mainly an abnormality in ventilatory control instability.5 6 The arousal threshold is one concept that has received some—but not sufficient—attention in the OSA arena.7 8 The trigger for arousal from sleep during respiratory events is believed to be increasing negative intrathoracic pressure9 (see figure 1). The realisation of the importance of the arousal threshold in the pathogenesis of OSA has recently been brought to light by the work of Younes, particularly the emphasis that most patients with OSA spontaneously have some periods of stable breathing.10 11 Jordan et al recently observed that these stable breathing periods were associated with markedly increased activity in the genioglossus, …
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Many patients with a high arousal threshold and sleep apnea experience a lowering of arousal threshold over time on therapy.
“many patients with a high arousal threshold with sleep apnea will experience a lowering of arousal threshold over time on therapy.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [418]
The main text (page not supplied) says that CPAP lowers the arousal threshold in patients with obstructive sleep apnoea, supporting the central point. It does not establish that this happens in many patients or specify that the lowering occurs over time on therapy; its reference to change over time concerns how the elevated threshold may develop. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe arousal threshold is not a fixed trait but changes with treatment.
“the arousal threshold is not a fixed trait but rather a dynamic phenomenon which changes with treatment.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [418]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Case records of the massachusetts general hospital
Hendren, W. H. (1966) · Journal of Pediatric Surgery · doi:10.1016/0022-3468(66)90052-2 · Cited by 1,893
Cabot, R. C., Scully, R. E., Mark, E. J., McNeely, W. F., McNeely, B. U., Harris, W. H., & Rosenberg, A. E. (1990) · New England Journal of Medicine · doi:10.1056/nejm199008233230808 · Cited by 896
Pathophysiology of Adult Obstructive Sleep Apnea
Eckert, D. J., & Malhotra, A. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200707-114mg · Cited by 719
Self-citationRole of Arousals in the Pathogenesis of Obstructive Sleep Apnea
Younes, M. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200307-1023oc · Cited by 456 · cited 1×
“The arousal threshold is one concept that has received some—but not sufficient—attention in the OSA arena.”
BackgroundThe Influence of Increasing Ventilatory Effort on Arousal from Sleep
Gleeson, K., Zwillich, C. W., & White, D. P. (1990) · American Review of Respiratory Disease · doi:10.1164/ajrccm/142.2.295 · Cited by 411
Ventilatory Control and Airway Anatomy in Obstructive Sleep Apnea
Wellman, A., Jordan, A. S., Malhotra, A., Fogel, R., Katz, E. S., Schory, K., EDWARDS, J. K., & White, D. P. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200404-510oc · Cited by 317
Self-citationHorner, R. L., Innes, J. A., Murphy, K., & Guz, A. (1991) · The Journal of Physiology · doi:10.1113/jphysiol.1991.sp018536 · Cited by 291
Effect of oxygen in obstructive sleep apnea: Role of loop gain
Wellman, A., Malhotra, A., Jordan, A. S., Stevenson, K. E., Gautam, S., & White, D. P. (2008) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2008.05.019 · Cited by 275
Self-citationRole of respiratory control mechanisms in the pathogenesis of obstructive sleep disorders
Younes, M. K. (2008) · Journal of Applied Physiology · doi:10.1152/japplphysiol.90408.2008 · Cited by 225
Mechanisms of breathing instability in patients with obstructive sleep apnea
Younes, M. K., Ostrowski, M., Atkar, R., Laprairie, J., Siemens, A., & Hanly, P. J. (2007) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00561.2007 · Cited by 179
Airway Dilator Muscle Activity and Lung Volume During Stable Breathing in Obstructive Sleep Apnea
Jordan, A. S., White, D. P., Lo, Y., Wellman, A., Eckert, D. J., Yim‐Yeh, S., Eikermann, M., Smith, S. A., Stevenson, K. E., & Malhotra, A. (2009) · SLEEP · doi:10.1093/sleep/32.3.361 · Cited by 167
Self-citationDeterminants of Ventilatory Instability in Obstructive Sleep Apnea: Inherent or Acquired?
Loewen, A., Ostrowski, M., Laprairie, J., Atkar, R., Gnitecki, J., Hanly, P., & Younes, M. (2009) · Sleep · doi:10.1093/sleep/32.10.1355 · Cited by 149
Mechanism of reduced LV afterload by systolic and diastolic positive pleural pressure
Fessler, H. E., Brower, R. G., Wise, R. A., & Permutt, S. (1988) · Journal of Applied Physiology · doi:10.1152/jappl.1988.65.3.1244 · Cited by 118
Stanchina, M. L., Malhotra, A., Fogel, R. B., Ayas, N., Edwards, J. K., Schory, K., & White, D. P. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.165.7.2108076 · Cited by 117
Self-citationDischarge Patterns of Human Genioglossus Motor Units During Sleep Onset
Wilkinson, V. E., Malhotra, A., Nicholas, C. L., Worsnop, C., Jordan, A. S., Butler, J. E., Saboisky, J. P., Gandevia, S. C., White, D. P., & Trinder, J. C. (2008) · SLEEP · doi:10.1093/sleep/31.4.525 · Cited by 116
Self-citationTrazodone increases arousal threshold in obstructive sleep apnoea
Heinzer, R. C., White, D. P., Jordan, A. S., Lo, Y. L., Dover, L., Stevenson, K., & Malhotra, A. (2008) · European Respiratory Journal · doi:10.1183/09031936.00067607 · Cited by 110
Self-citationSleep Apnea Impairs the Arousal Response to Airway Occlusion
Berry, R. B., Kouchi, K. G., Der, D. E., Dickel, M. J., & Light, R. W. (1996) · CHEST Journal · doi:10.1378/chest.109.6.1490 · Cited by 102
Effect of Ethanol on the Arousal Response to Airway Occlusion during Sleep in Normal Subjects
Berry, R. B., Bonnet, M. H., & Light, R. W. (1992) · American Review of Respiratory Disease · doi:10.1164/ajrccm/145.2_pt_1.445 · Cited by 99
Randomized Controlled Trial of Fluticasone in Preschool Children with Intermittent Wheeze
Pao, C., & McKenzie, S. A. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200203-265oc · Cited by 93
Jordan, A. S., McEvoy, R. D., EDWARDS, J. K., Schory, K., Yang, C., CATCHESIDE, P. G., Fogel, R., Malhotra, A., & White, D. P. (2004) · The Journal of Physiology · doi:10.1113/jphysiol.2004.064238 · Cited by 92
Self-citationThe Effects of Trazodone with l -Tryptophan on Sleep-disordered Breathing in the English Bulldog
Veasey, S. C., Fenik, P., Panckeri, K. A., Pack, A. I., & Hendricks, J. C. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.160.5.9812007 · Cited by 92
Genioglossal Muscle Response to CO2 Stimulation During NREM Sleep
Lo, Y., Jordan, A. S., Malhotra, A., Wellman, A., Heinzer, R. C., Schory, K., Dover, L., Fogel, R., & White, D. P. (2006) · SLEEP · doi:10.1093/sleep/29.4.470 · Cited by 85
Self-citationThe effects of oxygen in patients with sleep apnea.
Smith, P. L., Haponik, E. F., & Bleecker, E. R. (1984) · PubMed · doi:10.1164/arrd.1984.130.6.958 · Cited by 82
Ratnavadivel, R., Stadler, D. L., Windler, S., Bradley, J., Paul, D., McEvoy, R. D., & CATCHESIDE, P. G. (2009) · Thorax · doi:10.1136/thx.2008.112953 · Cited by 70
Control of breathing during sleep assessed by proportional assist ventilation
Meza, S., Giannouli, E., & Younes, M. K. (1998) · Journal of Applied Physiology · doi:10.1152/jappl.1998.84.1.3 · Cited by 70
Phasic electromyographic activity of the genioglossus increases in normals during slow-wave sleep
Basner, R. C., Ringler, J., Schwartzstein, R. M., Weinberger, S. E., & Weiss, J. W. (1991) · Respiration Physiology · doi:10.1016/0034-5687(91)90028-h · Cited by 67
Discharge Patterns of Human Genioglossus Motor Units during Arousal from Sleep
Wilkinson, V. E., Malhotra, A., Nicholas, C. L., Worsnop, C., Jordan, A. S., Butler, J. E., Saboisky, J. P., Gandevia, S. C., White, D. P., & Trinder, J. C. (2010) · SLEEP · doi:10.1093/sleep/33.3.379 · Cited by 51
Self-citationEffects of Enhancing Slow-Wave Sleep by Gamma-Hydroxybutyrate on Obstructive Sleep Apnea
Sériès, F., Sériès, I., & Cormier, Y. (1992) · American Review of Respiratory Disease · doi:10.1164/ajrccm/145.6.1378 · Cited by 43
Malhotra, A., Muse, V. V., & Mark, E. J. (2003) · New England Journal of Medicine · doi:10.1056/nejmcpc030005 · Cited by 43
Self-citationThe role of mean inspiratory effort on daytime sleepiness
Pelin, Z., Karadeniz, D., Öztürk, L., Gözükırmızı, E., & Kaynak, H. (2003) · European Respiratory Journal · doi:10.1183/09031936.03.00298903 · Cited by 35
Potential therapeutic targets in obstructive sleep apnoea
Saboisky, J. P., Chamberlin, N. L., & Malhotra, A. (2009) · Expert Opinion on Therapeutic Targets · doi:10.1517/14728220903005608 · Cited by 26
Self-citationIsono, S., Shimada, A., Tanaka, A., et al. (2003) · The Laryngoscope · doi:10.1097/00005537-200302000-00029 · Cited by 20
Airway Dilator Muscle Activity and Lung Volume During Stable Breathing in Obstructive Sleep Apnea
Amy S. Jordan, P., David P. White, M., Yu-Lun Lo, M., et al. (2009) · SLEEP · doi:10.5665/sleep/32.3.361 · Cited by 5
Mechanism of reduced LV afterload by systolic and diastolic positive pleural pressure
Fessler, H. E., Brower, R. G., & Wise, R. A. (1989) · Journal of Critical Care · doi:10.1016/0883-9441(89)90023-3 · Cited by 3
Flagged first, then by citations
Research works printed but not linked: 1
- [16]16. Stanchina M, Malhotra A, Fogel RB, et al. Genioglossus muscle responsiveness to chemical and mechanical loading during NREM sleep. Am J Respir Crit Care Med 2002;165:945e9.
Cited by
Sorted by citations
Bubu, O. M., Andrade, A. G., Umasabor-Bubu, O. Q., Hogan, M. M., Turner, A. D., de Leon, M. J., Ogedegbe, G., Ayappa, I., Jean-Louis G, G., Jackson, M. L., et al. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.101250 · Cited by 389
Eckert, D. J., Owens, R. L., Kehlmann, G. B., Wellman, A., Rahangdale, S., Yim-Yeh, S., White, D. P., & Malhotra, A. (2011) · Clinical Science · doi:10.1042/cs20100588 · Cited by 367
Self-citationInternational Consensus Statement on Obstructive Sleep Apnea
Chang, J. L., Goldberg, A. N., Alt, J. A., Mohammed, A., Ashbrook, L., Auckley, D., Ayappa, I., Bakhtiar, H., Barrera, J. E., Bartley, B. L., et al. (2023) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23079 · Cited by 350
Self-citationBi-directional relationships between co-morbid insomnia and sleep apnea (COMISA)
Sweetman, A., Lack, L., McEvoy, R. D., Smith, S., Eckert, D. J., Osman, A., Carberry, J. C., Wallace, D., Nguyen, P. D., & Catcheside, P. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101519 · Cited by 203
Self-citationMessineo, L., Eckert, D. J., Lim, R., Chiang, A., Azarbarzin, A., Carter, S. G., & Carberry, J. C. (2020) · The Journal of Physiology · doi:10.1113/jp280173 · Cited by 71
Self-citation
Metadata
- Authors
- Saboisky, J., Eckert, D., & Malhotra, A.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Malhotra, A.
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2010-02-01
- Volume
- 65
- Issue
- 2
- Pages
- 95-96
- ISSN
- 0040-6376 (ISSN-L)
- OpenAlex
- W2125514916
- Cited by
- 19
- References
- 34
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2013: 1 · 2012: 1
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- obstructive sleep apnea, arousal threshold, loop gain, genioglossus muscle activity, personalized treatment, palatal surgery, oxygen therapy, negative intrathoracic pressure
- MeSH terms
- Arousal, Humans, Respiratory Muscles, Sensory Thresholds, Respiratory Mechanics, Sleep Apnea, Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
