Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is considered to impair memory processing and increase the expression of amyloid-β (Aβ) and risk for Alzheimer’s disease (AD). Given the evidence that slow-wave sleep (SWS) is important in both memory and Aβ metabolism, a better understanding of the mechanisms by which...

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Autores principales:	Anna E. Mullins, Ankit Parekh, Korey Kam, Bresne Castillo, Zachary J. Roberts, Ahmad Fakhoury, Daphne I. Valencia, Reagan Schoenholz, Thomas M. Tolbert, Jason Z. Bronstein, Anne M. Mooney, Omar E. Burschtin, David M. Rapoport, Indu Ayappa, Andrew W. Varga
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	obstructive sleep apnea (OSA) sleep disordered breathing hypoxic burden sleep disruption arousal desaturation Physiology QP1-981
Acceso en línea:	https://doaj.org/article/b00fd74d7d704889a1ecdf5838c87716
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spelling	oai:doaj.org-article:b00fd74d7d704889a1ecdf5838c877162021-11-22T07:24:25ZSelective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea1664-042X10.3389/fphys.2021.750516https://doaj.org/article/b00fd74d7d704889a1ecdf5838c877162021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphys.2021.750516/fullhttps://doaj.org/toc/1664-042XObstructive sleep apnea (OSA) is considered to impair memory processing and increase the expression of amyloid-β (Aβ) and risk for Alzheimer’s disease (AD). Given the evidence that slow-wave sleep (SWS) is important in both memory and Aβ metabolism, a better understanding of the mechanisms by which OSA impacts memory and risk for AD can stem from evaluating the role of disruption of SWS specifically and, when such disruption occurs through OSA, from evaluating the individual contributions of sleep fragmentation (SF) and intermittent hypoxemia (IH). In this study, we used continuous positive airway pressure (CPAP) withdrawal to recapitulate SWS-specific OSA during polysomnography (PSG), creating conditions of both SF and IH in SWS only. During separate PSGs, we created the conditions of SWS fragmentation but used oxygen to attenuate IH. We studied 24 patients (average age of 55 years, 29% female) with moderate-to-severe OSA [Apnea-Hypopnea Index (AHI); AHI4% > 20/h], who were treated and adherent to CPAP. Participants spent three separate nights in the laboratory under three conditions as follows: (1) consolidated sleep with CPAP held at therapeutic pressure (CPAP); (2) CPAP withdrawn exclusively in SWS (OSASWS) breathing room air; and (3) CPAP withdrawn exclusively in SWS with the addition of oxygen during pressure withdrawal (OSASWS + O2). Multiple measures of SF (e.g., arousal index) and IH (e.g., hypoxic burden), during SWS, were compared according to condition. Arousal index in SWS during CPAP withdrawal was significantly greater compared to CPAP but not significantly different with and without oxygen (CPAP = 1.1/h, OSASWS + O2 = 10.7/h, OSASWS = 10.6/h). However, hypoxic burden during SWS was significantly reduced with oxygen compared to without oxygen [OSASWS + O2 = 23 (%min)/h, OSASWS = 37 (%min)/h]. No significant OSA was observed in non-rapid eye movement (REM) stage 1 (NREM 1), non-REM stage 2 (NREM 2), or REM sleep (e.g., non-SWS) in any condition. The SWS-specific CPAP withdrawal induces OSA with SF and IH. The addition of oxygen during CPAP withdrawal results in SF with significantly less severe hypoxemia during the induced respiratory events in SWS. This model of SWS-specific CPAP withdrawal disrupts SWS with a physiologically relevant stimulus and facilitates the differentiation of SF and IH in OSA.Anna E. MullinsAnkit ParekhKorey KamBresne CastilloZachary J. RobertsAhmad FakhouryDaphne I. ValenciaReagan SchoenholzThomas M. TolbertJason Z. BronsteinAnne M. MooneyOmar E. BurschtinDavid M. RapoportIndu AyappaAndrew W. VargaFrontiers Media S.A.articleobstructive sleep apnea (OSA)sleep disordered breathinghypoxic burdensleep disruptionarousaldesaturationPhysiologyQP1-981ENFrontiers in Physiology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	obstructive sleep apnea (OSA) sleep disordered breathing hypoxic burden sleep disruption arousal desaturation Physiology QP1-981
spellingShingle	obstructive sleep apnea (OSA) sleep disordered breathing hypoxic burden sleep disruption arousal desaturation Physiology QP1-981 Anna E. Mullins Ankit Parekh Korey Kam Bresne Castillo Zachary J. Roberts Ahmad Fakhoury Daphne I. Valencia Reagan Schoenholz Thomas M. Tolbert Jason Z. Bronstein Anne M. Mooney Omar E. Burschtin David M. Rapoport Indu Ayappa Andrew W. Varga Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea
description	Obstructive sleep apnea (OSA) is considered to impair memory processing and increase the expression of amyloid-β (Aβ) and risk for Alzheimer’s disease (AD). Given the evidence that slow-wave sleep (SWS) is important in both memory and Aβ metabolism, a better understanding of the mechanisms by which OSA impacts memory and risk for AD can stem from evaluating the role of disruption of SWS specifically and, when such disruption occurs through OSA, from evaluating the individual contributions of sleep fragmentation (SF) and intermittent hypoxemia (IH). In this study, we used continuous positive airway pressure (CPAP) withdrawal to recapitulate SWS-specific OSA during polysomnography (PSG), creating conditions of both SF and IH in SWS only. During separate PSGs, we created the conditions of SWS fragmentation but used oxygen to attenuate IH. We studied 24 patients (average age of 55 years, 29% female) with moderate-to-severe OSA [Apnea-Hypopnea Index (AHI); AHI4% > 20/h], who were treated and adherent to CPAP. Participants spent three separate nights in the laboratory under three conditions as follows: (1) consolidated sleep with CPAP held at therapeutic pressure (CPAP); (2) CPAP withdrawn exclusively in SWS (OSASWS) breathing room air; and (3) CPAP withdrawn exclusively in SWS with the addition of oxygen during pressure withdrawal (OSASWS + O2). Multiple measures of SF (e.g., arousal index) and IH (e.g., hypoxic burden), during SWS, were compared according to condition. Arousal index in SWS during CPAP withdrawal was significantly greater compared to CPAP but not significantly different with and without oxygen (CPAP = 1.1/h, OSASWS + O2 = 10.7/h, OSASWS = 10.6/h). However, hypoxic burden during SWS was significantly reduced with oxygen compared to without oxygen [OSASWS + O2 = 23 (%min)/h, OSASWS = 37 (%min)/h]. No significant OSA was observed in non-rapid eye movement (REM) stage 1 (NREM 1), non-REM stage 2 (NREM 2), or REM sleep (e.g., non-SWS) in any condition. The SWS-specific CPAP withdrawal induces OSA with SF and IH. The addition of oxygen during CPAP withdrawal results in SF with significantly less severe hypoxemia during the induced respiratory events in SWS. This model of SWS-specific CPAP withdrawal disrupts SWS with a physiologically relevant stimulus and facilitates the differentiation of SF and IH in OSA.
format	article
author	Anna E. Mullins Ankit Parekh Korey Kam Bresne Castillo Zachary J. Roberts Ahmad Fakhoury Daphne I. Valencia Reagan Schoenholz Thomas M. Tolbert Jason Z. Bronstein Anne M. Mooney Omar E. Burschtin David M. Rapoport Indu Ayappa Andrew W. Varga
author_facet	Anna E. Mullins Ankit Parekh Korey Kam Bresne Castillo Zachary J. Roberts Ahmad Fakhoury Daphne I. Valencia Reagan Schoenholz Thomas M. Tolbert Jason Z. Bronstein Anne M. Mooney Omar E. Burschtin David M. Rapoport Indu Ayappa Andrew W. Varga
author_sort	Anna E. Mullins
title	Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea
title_short	Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea
title_full	Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea
title_fullStr	Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea
title_full_unstemmed	Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea
title_sort	selective continuous positive airway pressure withdrawal with supplemental oxygen during slow-wave sleep as a method of dissociating sleep fragmentation and intermittent hypoxemia-related sleep disruption in obstructive sleep apnea
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/b00fd74d7d704889a1ecdf5838c87716
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Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea

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