Neural responses during Valsalva maneuvers in obstructive sleep apnea syndrome

• Published in: Journal of applied physiology (1985) 2003-03, Vol.94 (3), p.1063-1074
• Main Authors: Henderson, Luke A, Woo, Mary A, Macey, Paul M, Macey, Katherine E, Frysinger, Robert C, Alger, Jeffry R, Yan-Go, Frisca, Harper, Ronald M
• Format: Article
• Language: English
• Subjects: Adult; Airway Resistance - physiology; Autonomic Nervous System - physiopathology; Biological and medical sciences; Blood Pressure - physiology; Brain; Brain - physiopathology; Cluster Analysis; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Female; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system; Nervous system (semeiology, syndromes); Neurology; NMR; Nuclear magnetic resonance; Respiratory Mechanics; Sleep Apnea, Obstructive - physiopathology; Sleep disorders; Valsalva Maneuver - physiology
• ISSN: 8750-7587; 1522-1601
• DOI: 10.1152/japplphysiol.00702.2002

Departments of 1  Neurobiology, 2  Radiology, and 3  Neurology, 4  School of Nursing, University of California, Los Angeles, Los Angeles, California 90095-1763 The repetitive upper airway muscle atonic episodes and cardiovascular sequelae of obstructive sleep apnea (OSA) suggest dysfunction of specific neural sites that integrate afferent airway signals with autonomic and somatic outflow. We determined neural responses to the Valsalva maneuver by using functional magnetic resonance imaging. Images were collected during a baseline and three Valsalva maneuvers in 8 drug-free OSA patients and 15 controls. Multiple cortical, midbrain, pontine, and medullary regions in both groups showed intensity changes correlated to airway pressure. In OSA subjects, the left inferior parietal cortex, superior temporal gyrus, posterior insular cortex, cerebellar cortex, fastigial nucleus, and hippocampus showed attenuated signal changes compared with controls. Enhanced responses emerged in the left lateral precentral gyrus, left anterior cingulate, and superior frontal cortex of OSA patients. The anterior cingulate, cerebellar cortex, and posterior insula exhibited altered response timing patterns between control and OSA subjects. The response patterns in OSA subjects suggest deficits in particular neural pathways that normally mediate the Valsalva maneuver and compensatory actions in other structures. functional magnetic resonance imaging; cerebellum; insula; anterior cingulate; hippocampus