Current Hypertension Reports

, 16:476 | Cite as

Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation

  • Meghna P. MansukhaniEmail author
  • Tomas Kara
  • Sean M. Caples
  • Virend K. Somers
Hypertension and the Brain (S Stocker, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hypertension and the Brain


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.


Sleep disordered breathing Obstructive sleep apnea Hypoxia Hypercapnia Carotid body Peripheral chemoreceptors Autonomic imbalance Autonomic dysfunction Autonomic control Sympathetic activation Sympathetic activity Sympathetic response Sympathoexcitation Cardiovascular variability Heart rate variability Mechanisms Systemic hypertension Obesity Metabolic syndrome Renin angiotensin system Baroreflex Vascular factors Sleep deprivation 



This work was supported by the European Regional Development Fund - Project FNUSAICRC (No. CZ.1.05/1.1.00/02.0123) and by grant of IGA of Ministry of Health No. NT11401-5/2011 and the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R01HL065176. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Compliance with Ethics Guidelines

Conflict of Interest

Meghna P. Mansukhani, Tomas Kara, and Sean M. Caples each declare that they have no conflict of interest.

Virend K. Somers has served as a consultant for ResMed, Respicardia, PriceWaterhouse Coopers, and SORIN. Dr. Somers has also had research support derived from a gift from the Respironics Foundation to the Mayo Foundation.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Meghna P. Mansukhani
    • 1
    Email author
  • Tomas Kara
    • 2
    • 3
  • Sean M. Caples
    • 4
  • Virend K. Somers
    • 3
  1. 1.Sleep Medicine, Affiliated Communities Medical CenterWillmarUSA
  2. 2.International Clinical Research Center, Department of Cardiovascular DiseasesSt. Anne’s University Hospital BrnoBrnoCzech Republic
  3. 3.Division of Cardiovascular DiseasesMayo ClinicRochesterUSA
  4. 4.Center for Sleep Medicine, Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA

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