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Medical Comorbidities of Obstructive Sleep Apnea

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Dental Sleep Medicine

Abstract

Proper sleep is necessary for the body to maintain homeostasis. Sleep disorders are associated with physiological and psychological medical conditions, classified by the International Classification of Sleep Disorders (ICSD). In the third edition of the ICSD, Obstructive Sleep Apnea (OSA) is classified under Sleep-Related Disorder Breathing (SRDB) and is subcategorized as adult and pediatric OSA.

OSA is a sleep-related breathing disorder characterized by episodes of breathing cessation (apnea) or reduction in airflow (hypopnea) that lasts more than 10 seconds, occurring more than five times per hour of sleep. Approximately 1 billion of the world’s population, between 30 and 69 years, are estimated to have OSA. ROSA risk factors of OSA include obesity, gender, age, genetics, and craniofacial as well as orofacial abnormalities. Common symptoms include fatigue, tiredness, lack of energy, chronic snoring, witnessed apneas during sleep, and nocturnal gasping/choking isbeing the most reliable indicator of OSA.

Other symptoms may include chronic morning headaches, nocturnal gastroesophageal reflux, nocturnal sweating, and decreased libido.

OSA is associated with an increased risk of medical conditions and comorbidities, such as hypertension, arrhythmias, stroke, chronic renal failure, metabolic syndrome, irritable bowel syndrome, diabetes, obesity, enlarged upper airway soft tissue, headache, mood disorders, and cognitive impairment such as deficit in attention, executive functions, and memory. This chapter offers an overview of OSA and its medical comorbidities.

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Abbreviations

AASM:

American Association of Sleep Medicine

AD:

Alzheimer’s disease

AHI:

Apnea-hypopnea index

ASDC:

Association of Sleep Disorders Centers

BMI:

Body mass index

BP:

Blood pressure

CKD:

Chronic kidney disease

CPAP:

Continuous positive airway pressure

CSA:

Central sleep apnea

DCSAD:

Diagnostic Classification of Sleep and Arousal Disorders

DSA:

Dental sleep appliance

ED:

Erectile dysfunction

EDA:

Electrodermal activity

EDS:

Excessive daytime sleepiness

ESRD:

End-stage renal disease

ESS:

Epworth Sleepiness Scale

GERD:

Gastroesophageal reflux

HDL:

High-density lipoprotein

IBS:

Irritable bowel syndrome

ICHD-3:

International Classification of Headache Disorders, Third Edition

ICSD:

International Classification of Sleep Disorders

IHS:

International Headache Society

LES:

Lower esophageal sphincter

MA:

Micro-arousal

MDD:

Major depressive disorder

MDH:

Medullary dorsal horn

NREM:

Non-rapid eye movement

OSA:

Obstructive sleep apnea

PSG:

Polysomnography

PTSD:

Posttraumatic stress disorder

RAAS:

Renin-angiotensin-aldosterone system

REM:

Rapid eye movement

RVLM:

Rostral ventrolateral medulla

SAH:

Sleep apnea headache

SB:

Sleep bruxism

SHHS:

Sleep Heart Health Study

SRBD:

Sleep-related breathing disorders

TCR:

Trigemino-cardiac reflex

TMD:

Temporomandibular joint disorder

TST:

Total sleep time

TTH:

Tension-type headache

References

  1. American Academy of Sleep Medicine. The international classification of sleep disorders, revised (ICSD-R) (PDF); 2001. ISBN 0-9657220-1-5. Archived from the original (PDF) on 2011-07-26. Accessed 8 Aug 2010.

    Google Scholar 

  2. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd edition. Chest. 2014;146(5):1387–94. https://doi.org/10.1378/chest.14-0970.

    Article  Google Scholar 

  3. Roffwarg HP. Diagnostic classification of sleep and arousal disorders. 1979 first edition. Association of Sleep Disorders Centers and the Association for the Psychophysiological Study of Sleep. Sleep. 1979;2:1154. https://doi.org/10.1093/sleep/2.1.1. PMID: 531417.

    Article  Google Scholar 

  4. Thorpy MJ. Classification of sleep disorders. J Clin Neurophysiol. 1990;7(1):67–81. PMID: 2406285.

    Article  PubMed  Google Scholar 

  5. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597–619. PMID: 23066376.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Epstein LJ, Kristo D, Strollo PF Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–76. PMID: 19960649.

    Article  PubMed  Google Scholar 

  7. Mansukhani MP, Kolla BP, Wang Z, Morgenthaler TI. Effect of varying definitions of hypopnea on the diagnosis and clinical outcomes of sleep disordered breathing: a systematic review and meta-analysis. J Clin Sleep Med. 2019;15(5):687–96. PMID: 31053203.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pepin JL, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7:687–98. PMID: 31300334.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea. JAMA. 2020;323(14):1389–400. PMID: 32286648.

    Article  PubMed  Google Scholar 

  10. Lavigne GJ, Babiloni AH, Beetz G, Dal Fabbro C, Sutherland K, Huynh N, Cistulli PA. Critical issues in dental and medical management of obstructive sleep apnea. J Dent Res. 2020;99(1):26–35. PMID: 31702942.

    Article  PubMed  Google Scholar 

  11. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14. https://doi.org/10.1093/aje/kws342. PMID: 23589584.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47–112. https://doi.org/10.1152/physrev.00043.2008. PMID: 20086074.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ferris BG Jr, Mead J, Opie LH. Partitioning of respiratory flow resistance in man. J Appl Physiol. 1964;19:653–8. PMID: 14195575.

    Article  PubMed  Google Scholar 

  14. Michels DS, Rodrigues A, Nakanishi M, Sampaio A, Venosa A. Nasal involvement in obstructive sleep apnea syndrome. Int J Otolaryngol. 2014;2014:717419. PMID: 25548569.

    Article  PubMed Central  Google Scholar 

  15. Arnardottir E, Janson C, Bjornsdottir E, Benediktsdottir B, Juliusson S, Kuna S, Pack A, Gislason T. Nocturnal sweating—a common symptom of obstructive sleep apnoea: the Icelandic sleep apnoea cohort. Respir Med. 2013;3(5):e002795. https://doi.org/10.1136/bmjopen-2013-002795. PMID: 23674447.

    Article  Google Scholar 

  16. Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax. 1992;47(2):101–5. https://doi.org/10.1136/thx.47.2.101. PMID: 1549815.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Guilleminault C, Black JE, Palombini L, Ohayon M. A clinical investigation of obstructive sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS) patients. Sleep Med. 2000;1(1):51–6. https://doi.org/10.1016/S1389-9457(99)00011-8. PMID: 10733620.

    Article  PubMed  Google Scholar 

  18. Lim KG, Morgenthaler TI, Katzka DA. Sleep and nocturnal gastroesophageal reflux: an update. Chest. 2018;154(4):963–71. https://doi.org/10.1016/j.chest.2018.05.030. PMID: 29859888.

    Article  PubMed  Google Scholar 

  19. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea? The Rational Clinical Examination systematic review. JAMA. 2013;310(7):731–41. https://doi.org/10.1001/jama.2013.276185. PMID: 23989984.

    Article  PubMed  Google Scholar 

  20. Petersen M, Kristensen E, Berg S, Giraldi A, Midgren B. Sexual function in female patients with obstructive sleep apnea. J Sex Med. 2011;8(9):2560–8. PMID: 21699663.

    Article  PubMed  Google Scholar 

  21. Chung F, Yegneswaran B, Liao P, Chung S, Vairavanathan S, Islam S, Khajehdehi A, Shapiro C. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–21. https://doi.org/10.1097/ALN.0b013e31816d83e4. PMID: 18431116.

    Article  PubMed  Google Scholar 

  22. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–5. https://doi.org/10.1093/sleep/14.6.540. PMID: 1798888.

    Article  PubMed  Google Scholar 

  23. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–91. https://doi.org/10.7326/0003-4819-131-7-199910050-00002. PMID: 10507956.

    Article  PubMed  Google Scholar 

  24. Caporale M, Palmeri R, Corallo F, Muscarà N, Romeo L, Bramanti A, Marino S, Lo Buono V. Cognitive impairment in obstructive sleep apnea syndrome: a descriptive review. Sleep Breath. 2020;25:29–40. https://doi.org/10.1007/s11325-020-02084-3. PMID: 32447633.

    Article  PubMed  Google Scholar 

  25. Aurora RN, Casey KR, Kristo D, et al. American Academy of Sleep Medicine. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010;33(10):1408–13. https://doi.org/10.1093/sleep/33.10.1408. PMID: 21061864.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Edwards BA, Andara C, Landry S, et al. Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2016;194(11):1413–22. https://doi.org/10.1164/rccm.201601-0099OC. PMID: 27181367.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gao XM, Zeng XL, Fu MK, Huang XZ. Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after oral appliance therapy. Chin J Dent Res. 1999;2(2):27–35. PMID: 10863404.

    PubMed  Google Scholar 

  28. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2019;15(2):301–34. https://doi.org/10.5664/jcsm.7638. PMID: 30736888.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P. Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159(7):471–83. https://doi.org/10.7326/0003-4819-159-7-201310010-00704. PMID: 24061345.

    Article  PubMed  Google Scholar 

  30. Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773–827. https://doi.org/10.5664/jcsm.4858. PMID: 26094920.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Casale M, Pappacena M, Rinaldi V, Bressi F, Baptista P, SalvinelliI F. Obstructive sleep apnea syndrome: from phenotype to genetic basis. Curr Genomics. 2009;10:119–26. https://doi.org/10.2174/138920209787846998. PMID: 19794884.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lavigne GJ, Cistulli PA, Smith MT. Sleep medicine for dentists. Chicago: Quintessence Pub.; 2009. Print.

    Google Scholar 

  33. Adeseun GA, Rosas SE. The impact of obstructive sleep apnea on chronic kidney disease. Curr Hypertens Rep. 2010;12(5):378–83. https://doi.org/10.1007/s11906-010-0135-1. PMID: 20676805.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Boyer S, Kapur V. Obstructive sleep apnea: its relevance in the care of diabetic patients. Clin Diabetes. 2002;20(3):126–32. https://doi.org/10.2337/diaclin.20.3.126.

    Article  Google Scholar 

  35. Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnea severity in women. Chest. 1995;107(2):362–6. https://doi.org/10.1378/chest.107.2.362. PMID: 7842762.

    Article  PubMed  Google Scholar 

  36. O’Connor CH, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med. 2000;161(5):1465–72. https://doi.org/10.1164/ajrccm.161.5.9904121. PMID: 10806140.

    Article  PubMed  Google Scholar 

  37. Hamans EP, Van Marck EA, De Backer WA, Creten W, Van de Heying PH. Morphometric analysis of the uvula in patients with sleep-related breathing disorders. Eur Arch Otorhinolaryngol. 2000;257:232–6. https://doi.org/10.1007/s004050050229. PMID: 10867841.

    Article  PubMed  Google Scholar 

  38. Mortimore IL, Marshall I, Wraith PK, Sellar RJ, Douglas NJ. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med. 1998;157:280–3. https://doi.org/10.1164/ajrccm.157.1.9703018. PMID: 9445310.

    Article  PubMed  Google Scholar 

  39. Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152:1673–89. https://doi.org/10.1164/ajrccm.152.5.7582313. PMID: 7582313.

    Article  PubMed  Google Scholar 

  40. McNamara JP, Wang J, Holiday DB, Warren JY, Paradoa M, Balkhi AM, Fernandez-Baca J, McCrae CS. Sleep disturbances associated with cigarette smoking. Psychol Health Med. 2014;19(4):410–9.

    Article  PubMed  Google Scholar 

  41. Hassamal S, Miotto K, Wang T, Saxon AJ. A narrative review: the effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients. Am J Addict. 2016;25(6):452–65. https://doi.org/10.1111/ajad.12424. PMID: 27554389.

    Article  PubMed  Google Scholar 

  42. Walker JM, Farney RJ, Rhondeau SM, Boyle KM, Valentine K, Cloward TV, Shilling KC. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J Clin Sleep Med. 2007;3(5):455–61. PMID: 17803007.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Guilleminault C. Benzodiazepines, breathing, and sleep. Am J Med. 1990;88(3):S25–8. https://doi.org/10.1016/0002-9343(90)90282-i. PMID: 1968716.

    Article  Google Scholar 

  44. He S, Hasler BP, Chakravorty S. Alcohol and sleep-related problems. Curr Opin Psychol. 2019;30:117–22. https://doi.org/10.1016/j.copsyc.2019.03.007. PMID: 31128400.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kolla BP, Foroughi M, Saeidifard F, Chakravorty S, Wang Z, Mansukhani MP. The impact of alcohol on breathing parameters during sleep: a systematic review and meta-analysis. Sleep Med Rev. 2018;42:59–67. https://doi.org/10.1016/j.smrv.2018.05.007. PMID: 30017492.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ohyan M. From wakefulness to excessive sleepiness: what we know and still need to know. Sleep Med Rev. 2008;12(2):129–41. https://doi.org/10.1016/j.smrv.2008.01.001. PMID: 18342261.

    Article  Google Scholar 

  47. Slater G, Steier J. Excessive daytime sleepiness in sleep disorders. J Thorac Dis. 2012;4(6):608–16. https://doi.org/10.3978/j.issn.2072-1439.2012.10.07. PMID: 23205286.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Liistro G, Stănescu DC, Stănescu DC, Veriter C, Rodenstein DO, Aubert-Tulkens G. Pattern of snoring in obstructive sleep apnea patients and in heavy snorers. Sleep. 1991;14(6):517–25.

    Article  PubMed  Google Scholar 

  49. Arnardottir E, Janson C, Bjornsdottir E, Benediktsdottir B, Juliusson S, Kuna S, Pack A, Gislason T. Nocturnal Sweating—a common symptom of obstructive sleep apnoea: the Icelandic sleep apnoea cohort. Respir Med BMJ Open. 2013;3(5):e002795. https://doi.org/10.1136/bmjopen-2013-002795. PMID: 23674447.

    Article  Google Scholar 

  50. Lowenstein L, Kenton K, Brubaker L, Pillar G, Undevia N, Mueller ER, et al. The relationship between obstructive sleep, nocturia, and daytime overactive bladder syndrome in women. AM J Obstet Gynecol. 2008;198:598.e1–5. https://doi.org/10.1016/j.ajog.2008.02.024. PMID: 18455544.

    Article  Google Scholar 

  51. Anderson JV, Maxwell DL, Payne NN, Slater JD, Bloom SR. Atrial natriuretic peptide: physiological release associated with natriuresis during negative pressure breathing in man. Clin Sci (Lond). 1989;76:423–9. https://doi.org/10.1042/cs0760423. PMID: 2523770.

    Article  Google Scholar 

  52. Park E, Park J, Kim J, et al. Relationship between nocturia, obstructive sleep apnea, and quality of sleep. KMID: 1034320150060010028.

    Google Scholar 

  53. Umlauf MG, Chasens ER. Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep Med Rev. 2003;7:403–11. https://doi.org/10.1053/smrv.2002.0273. PMID: 14573376.

    Article  PubMed  Google Scholar 

  54. Umlauf MG, Chasens ER, Greevy RA, Arnold J, Burgio KL, Pillion DJ. Obstructive sleep apnea, nocturia and polyuria in older adults. Sleep. 2004;27:139–44. https://doi.org/10.1093/sleep/27.1.139. PMID: 14998251.

    Article  PubMed  Google Scholar 

  55. Baruzzi A, Riva R, Cirignotta F, Zucconi M, Cappelli M, Lugaresi E. Atrial natriuretic peptide and catecholamines in obstructive sleep apnea syndrome. Sleep. 1991;14:83–6. https://doi.org/10.1093/sleep/14.1.83. PMID: 1839810.

    Article  PubMed  Google Scholar 

  56. Guilleminault C. Sleep apnea syndromes: impact of sleep and sleep states. Sleep. 1980;3:227–34. https://doi.org/10.1093/sleep/3.3-4.227. PMID: 7221333.

    Article  PubMed  Google Scholar 

  57. Krieger J, Laks L, Wilcox I, Grunstein RR, Costas LJ, McDougall JG, Sullivan CE. Atrial natriuretic peptide release during sleep in patients with obstructive sleep apnoea before and during treatment with nasal continuous positive airway pressure. Clin Sci (Lond). 1989;77:407–11. https://doi.org/10.1042/cs0770407. PMID: 2530023.

    Article  Google Scholar 

  58. Margel D, Shochat T, Getzler O, Livne PM, Pillar G. Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology. 2006;67:974–7. https://doi.org/10.1016/j.urology.2005.11.054. PMID: 16635510.

    Article  PubMed  Google Scholar 

  59. Shiomi T, Guilleminault C, Stoohs R, Schnittger I. Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest. 1991;100:894–902. https://doi.org/10.1378/chest.100.4.894. PMID: 1914603.

    Article  PubMed  Google Scholar 

  60. Budweiser S, Enderlein S, Jorres RA, Hitzl AP, Weiland WF, Pfeifer M, Arzt M. Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med. 2009;6(11):3147–57. https://doi.org/10.1111/j.1743-6109.2009.01372.x. PMID: 19570042.

    Article  PubMed  Google Scholar 

  61. Soukhova-O'Hare GK, Shah ZA, Lei Z, Nozdrachev AD, Rao CV, Gozal D. Erectile dysfunction in a murine model of sleep apnea. Am J Respir Crit Care Med. 2008;178(6):644–50. https://doi.org/10.1164/rccm.200801-190OC. PMID: 18535258.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Zhang XB, Lin QC, Zeng HQ, Jiang XT, Chen B, Chen X. Erectile dysfunction and sexual hormone levels in men with obstructive sleep apnea: efficacy of continuous positive airway pressure. Arch Sex Behav. 2016;45(1):235–40. https://doi.org/10.1007/s10508-015-0593-2. PMID: 26370402.

    Article  PubMed  Google Scholar 

  63. Taskin U, Yigit O, Acioglu E, Aricigil M, Toktas G, Guzelhan Y. Erectile dysfunction in severe sleep apnea patients and response to CPAP. Int J Impot Res. 2009;22(2):134–9. https://doi.org/10.1038/ijir.2009.54. PMID: 19940853.

    Article  PubMed  Google Scholar 

  64. Eckert DJ, Lo YL, Saboisky JP, Jordan AS, White DP, Malhotra A. Sensorimotor function of the upper-airway muscles and respiratory sensory processing in untreated obstructive sleep apnea. J Appl Physiol. 2011;111:1644–53. PMID: 21885797.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H, Torigian DA, Pack AI, Schwab RJ. Tongue fat and its relationship to obstructive sleep apnea. Sleep. 2014;37(10):1639–48. https://doi.org/10.5665/sleep.4072. PMID: 25197815.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep disordered breathing. JAMA. 2000;284(23):3015–21. https://doi.org/10.1001/jama.284.23.3015. PMID: 11122588.

    Article  PubMed  Google Scholar 

  67. Jehan S, Zizi F, Pandi-Oerumal SR, Wall S, Auguste E, Myers AK, Jean-Louis G, McFarlane SI. Sleep apnea and obesity: implications for public health. Sleep Med Disord. 2017;1(4):00019. PMID: 29517065.

    PubMed  PubMed Central  Google Scholar 

  68. Calhoun DA, Harding SM. Sleep and hypertension. Chest. 2010;138(2):434–43. https://doi.org/10.1378/chest.09-2954. PMID: 20682533.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Dopp JM, Reichmuth KJ, Morgan BJ. Obstructive sleep apnea and hypertension: mechanisms, evaluation, and management. Curr Hypertens Rep. 2007;9(6):529–34. https://doi.org/10.1007/s11906-007-0095-2. PMID: 18367017.

    Article  PubMed  Google Scholar 

  70. O’Connor GT, Caffo B, Newman AB, et al. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009;179(12):1159–64. https://doi.org/10.1164/rccm.200712-1809OC. PMID: 19264976.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R, Jagia P, Kumar A. Retraction: CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365:2277–86. N Engl J Med. 2013;369(18):1770. https://doi.org/10.1056/NEJMc1313105. PMID: 24171540.

    Article  PubMed  Google Scholar 

  72. Martínez-García MA, Gómez-Aldaraví R, Soler-Cataluña JJ, Martínez TG, Bernácer-Alpera B, Román-Sánchez P. Positive effect of CPAP treatment on the control of difficult-to-treat hypertension. Eur Respir J. 2007;29(5):951–7. https://doi.org/10.1183/09031936.00048606. Epub 2007 Feb 14. PMID: 17301092.

    Article  PubMed  Google Scholar 

  73. Alajmi M, Mulgrew AT, Fox J, Davidson W, Schulzer M, Mak E, Ryan CF, Fleetham J, Choi P, Ayas NT. Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea: a meta-analysis of randomized controlled trials. Lung. 2007;185(2):67–72. PMID: 17393240.

    Article  PubMed  Google Scholar 

  74. Bazzano LA, Khan Z, Reynolds K, He J. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension. 2007;50(2):417–23. https://doi.org/10.1161/HYPERTENSIONAHA.106.085175. PMID: 17548722.

    Article  PubMed  Google Scholar 

  75. Haentjens P, Van Meerhaeghe A, Moscariello A, Weerdt SD, Poppe K, Dupont A, Velkeniers B. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. 2007;167(8):757–64. PMID: 17452537.

    Article  PubMed  Google Scholar 

  76. Mo L, He QY. Effect of long-term continuous positive airway pressure ventilation on blood pressure in patients with obstructive sleep apnea hypopnea syndrome: a meta-analysis of clinical trials [in Chinese]. Zhonghua Yi Xue Za Zhi. 2007;87(17):1177–80. PMID: 17686236.

    PubMed  Google Scholar 

  77. Ong J, Crawford M. Insomnia and obstructive sleep apnea. Sleep Med Clin. 2013;8(3):389–98. https://doi.org/10.1016/j.jsmc.2013.04.004. PMID: 24015117.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Luyster F, Buysse D, Strollo P. Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. J Clin Sleep Med. 2010;6(2):196–204. PMID: 20411700.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Krakow B, Romero E, Ulibarri V. Prospective assessment of nocturnal awakenings in a case series of treatment-seeking chronic insomnia patients: a pilot study of subjective and objective causes. Sleep. 2012;35(12):1685–92. https://doi.org/10.5665/sleep.2244. PMID: 23204611.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Björnsdóttir E, Janson C, Sigurdsson JF, et al. Symptoms of insomnia among OSA patients before and after 2 years of PAP treatment. Sleep. 2013;36(12):1901–9. https://doi.org/10.5665/sleep.3226. PMID: 24293765.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Lack LC, Hunter M, Gradisar M, Harris JK. Is the treatment of insomnia impaired when OSA is also present? Sleep (Abstract Suppl). 2011;34:A174.

    Google Scholar 

  82. Kent BD, Grote L, Ryan S, et al. Diabetes mellitus prevalence and control in sleep disordered breathing: the European Sleep Apnea Cohort (ESADA) study. Chest. 2014;146(4):982–90. https://doi.org/10.1378/chest.13-2403. PMID: 24831859.

    Article  PubMed  Google Scholar 

  83. Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: is there a link? Front Neurol. 2012;3:126. https://doi.org/10.3389/fneur.2012.00126. PMID: 23015803.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Pujabi NM. Do sleep disorders and associated treatments impact glucose metabolism? Drugs. 2009;69:13–27. PMID: 20047348.

    Article  Google Scholar 

  85. Attanasio R, Bailey DR. Sleep medicine and dentistry. 1st ed. Philadelphia, PA: Saunders; 2012.

    Google Scholar 

  86. Demerjian GG, Barkordarian A, Chiappelli F. Temporomandibular joint disorders and airway disorders. A translational perspective (Chapter 8). Springer; 2018. p. 135–72.

    Google Scholar 

  87. Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. Association of sleep time with diabetes mellitus and impaired glucose tolerance. J Appl Physiol. 2005;99:1998–2007. PMID: 16227461.

    Article  PubMed  Google Scholar 

  88. Spiegel R, Knudtson K, Leproult R, Tasali E, Van Cauter E. Sleep loss: a novel risk factor for insulin resistance and type II diabetes. J Appl Physiol. 2005;99:2008–19. https://doi.org/10.1152/japplphysiol.00660.2005. PMID: 16227462.

    Article  PubMed  Google Scholar 

  89. Bialasiewicz P, Czupryniak L, Pawlowski M, Nowak D. Sleep disordered breathing in REM sleep reverses the downward trend in glucose concentration. Sleep Med. 2011;12:76–82. PMID: 21051282.

    Article  PubMed  Google Scholar 

  90. Grimaldi D, Beccuti G, Touma C, Cauter EV, Mokhlesi B. Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications. Diabetes Care. 2014;37(2):355–63. https://doi.org/10.2337/dc13-0933. PMID: 24101701.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Alkhalili M, Schulman ES, Getsy J. Obstructive sleep apnea syndrome and asthma: what are the links? J Clin Sleep Med. 2009;5(1):71–8. PMID: 19317386.

    Article  Google Scholar 

  92. Ciftci TU, Ciftci B, Guven SF, Kokturk O, Turktas H. Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome. Respir Med. 2005;99:529–34. PMID: 15823448.

    Article  PubMed  Google Scholar 

  93. Teodorescu M, Polomis DA, Hall SV, Teodorescu MC, Gangnon RE, Peterson AG, et al. Association of obstructive sleep apnea risk with asthma control in adults. Chest. 2010;138:543–50. https://doi.org/10.1378/chest.09-3066. PMID: 20495105.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Teodorescu M, Barnet JH, Hagen EW, Palta M, Young TB, Peppard PE. Association between asthma and risk of developing obstructive sleep apnea. JAMA. 2015;313:156–64. https://doi.org/10.1001/jama.2014.17822. PMID: 25585327.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Graf KI, Karaus M, Heinemann S, Körber S, Dorow P, Hampel KE. Gastroesophageal reflux in patients with sleep apnea syndrome. Z Gastroenterol. 1995;33:689–93. PMID: 8585249.

    PubMed  Google Scholar 

  96. Green BT, Broughton WA, O’Connor JB. Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure. Arch Intern Med. 2003;163:41–5. PMID: 12523915.

    Article  PubMed  Google Scholar 

  97. Herr J. Chronic cough, sleep apnea, and gastroesophageal reflux disease. Chest. 2001;120:1036–7. https://doi.org/10.1378/chest.120.3.1036. PMID: 11555550.

    Article  PubMed  Google Scholar 

  98. Jung H, Choung RS, Talley NJ. Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications. J Neurogastroenterol Motil. 2010;16(1):22. https://doi.org/10.5056/jnm.2010.16.1.22.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Konermann M, Radu HJ, Teschler H, Rawert B, Heimbucher J, Sanner BM. Interaction of sleep disturbances and gastroesophageal reflux in chronic laryngitis. Am J Otolaryngol. 2002;23:20–6. PMID: 11791245.

    Article  PubMed  Google Scholar 

  100. Shepard K, Orr W. Mechanism of gastroesophageal reflux in obstructive sleep apnea: airway obstruction or obesity? J Clin Sleep Med. 2016;12(1):87–94. https://doi.org/10.5664/jcsm.5402.

    Article  Google Scholar 

  101. Salles C, Ramos R, Machado A, et al. What we know about gastroesophageal reflux disease and obstructive sleep apnea? Sleep Sci. 2013;6:3.

    Google Scholar 

  102. Fass R. Effect of gastroesophageal reflux disease on sleep. J Gastroenterol Hepatol. 2010;25:S41–4. PMID: 20586864.

    Article  PubMed  Google Scholar 

  103. Teramoto S, Sudo E, Takeshi M, Ohga E, Ishii T, Ouchi Y, Fukuchi Y. Impaired swallowing reflex in patients with obstructive sleep apnea syndromes. Chest. 1999;116:17–21. https://doi.org/10.1378/chest.116.1.17. PMID: 10424498.

    Article  PubMed  Google Scholar 

  104. Ing AJ, Ngu MC, Breslin AB. Obstructive sleep apnea and gastroesophageal reflux. Am J Med. 2000;108:S120–5. https://doi.org/10.1016/s0002-9343(99)00350-2. PMID: 10718464.

    Article  Google Scholar 

  105. Senior BA, Khan M, Schwimmer C, Rosenthal L, Benninger M. Gastroesophageal reflux and obstructive sleep apnea. Laryngoscope. 2001;111:2144–6. https://doi.org/10.1097/00005537-200112000-00012. PMID: 11802013.

    Article  PubMed  Google Scholar 

  106. Ghiasi F, Amra B, Sebghatollahi V, Azimian F. Association of irritable bowel syndrome and sleep apnea in patients referred to sleep laboratory. J Res Med Sci. 2017;22:72. https://doi.org/10.4103/jrms.JRMS_523_16. eCollection 2017. PMID: 28717369.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Manabe N, Tanaka T, Hata J, Kusunoki H, Haruma K. Pathophysiology underlying irritable bowel syndrome—from the viewpoint of dysfunction of autonomic nervous system activity. J Smooth Muscle Res. 2009;45:15–23. https://doi.org/10.1540/jsmr.45.15. PMID: 19377269.

    Article  PubMed  Google Scholar 

  108. Rotem AY, Sperber AD, Krugliak P, Freidman B, Tal A, Tarasiuk A. Polysomnographic and actigraphic evidence of sleep fragmentation in patients with irritable bowel syndrome. Sleep. 2003;26(6):747–52. https://doi.org/10.1093/sleep/26.6.747. PMID: 14572130.

    Article  PubMed  Google Scholar 

  109. Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med. 2005;142(3):187–97. PMID: 15684207.

    Article  PubMed  Google Scholar 

  110. Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, Malhotra A, Martinez-Garcia MA, Mehra R, Pack AI, Polotsky VY. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69(7):841–58. PMID: 28209226.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med. 2010;6(2):131–7. PMID: 20411688.

    Article  PubMed  PubMed Central  Google Scholar 

  112. Lee CH, Sethi R, Li R, Ho HH, Hein T, Jim MH, Loo G, Koo CY, Gao XF, Chandra S, Yang, et al. Obstructive sleep apnea and cardiovascular events after percutaneous coronary intervention. Circulation. 2016;133(21):2008–17. PMID: 27178625.

    Article  PubMed  Google Scholar 

  113. Williams A, Scharf SM. Obstructive sleep apnea, cardiovascular disease, and inflammation—is NF-κB the key? Sleep Breath. 2007;11(2):69–76. https://doi.org/10.1007/s11325-007-0106-1. PMID: 17380355.

    Article  PubMed  Google Scholar 

  114. Worsnop CJ, Naughton MT, Barter CE, Morgan TO, Anderson AI, Pierce RJ. The prevalence of obstructive sleep apnea in hypertensives. Am J Respir Crit Care Med. 1998;157(1):111–5. https://doi.org/10.1164/ajrccm.157.1.9609063. PMID: 9445287.

    Article  PubMed  Google Scholar 

  115. Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med. 2012;156:115–22. PMID: 22250142.

    Article  PubMed  Google Scholar 

  116. Ge X, Han F, Huang Y, Zhang Y, Yang T, Bai C, Guo X. Is obstructive sleep apnea associated with cardiovascular and all-cause mortality? PLoS One. 2013;9(4):e95953. https://doi.org/10.1371/journal.pone.0069432. PMID: 23936014.

    Article  Google Scholar 

  117. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53. https://doi.org/10.1016/S0140-6736(05)71141-7. PMID: 15781100.

    Article  PubMed  Google Scholar 

  118. Sandu N, Spiriev T, Lemaitre F, Filis A, Schaller B, Trigemino-Cardiac Reflex Examination Group (TCREG). New molecular knowledge towards the trigemino-cardiac reflex as a cerebral oxygen-conserving reflex. ScientificWorldJournal. 2010;10:811–7. https://doi.org/10.1100/tsw.2010.71. PMID: 20454763.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Schaller B, Cornelius JF, Sandu N, Ottaviani G, Perez-Pinzon MA. Oxygen-conserving reflexes of the brain: the current molecular knowledge. J Cell Mol Med. 2009;13:644–7. https://doi.org/10.1111/j.1582-4934.2009.00659.x. PMID: 19438971.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Demerjian GG, Barkordarian A, Chiappelli F. Temporomandibular joint disorders and airway disorders. A translational perspective (Chapter 8). Springer; 2018. p. 3–16.

    Google Scholar 

  121. Chowdhury T, Bindu B, Singh GP, Schaller B. Sleep disorders: is the trigeminal cardiac reflex a missing link? Front Neurol. 2017;8:63. https://doi.org/10.3389/fneur.2017.00063. PMID: 28289401.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Butler PJ, Jones DR. Physiology of diving of birds and mammals. Physiol Rev. 1997;77:837–99. https://doi.org/10.1152/physrev.1997.77.3.837. PMID: 9234967.

    Article  PubMed  Google Scholar 

  123. Feldman JL. Neurophysiology of breathing in mammals. In: Bloom FE, editor. Handbook of physiology, the nervous system: intrinsic regulatory systems of the brain, vol. 4. Bethesda, MD: American Physiological Society; 1986. p. 463–524.

    Google Scholar 

  124. Stocker SD, Steinbacher BC Jr, Balaban CD, et al. Connections of the caudal ventrolateral medullary reticular formation in the cat brainstem. Exp Brain Res. 1997;116:270–82. https://doi.org/10.1007/pl00005755. PMID: 9348126.

    Article  PubMed  Google Scholar 

  125. McCulloch PF, Faber KM, Panneton WM. Electrical stimulation of the anterior ethmoidal nerve produces the diving response. Brain Res. 1999;830:24–31. https://doi.org/10.1016/s0006-8993(99)01374-8. PMID: 10350556.

    Article  PubMed  Google Scholar 

  126. Healy DP, Jew JY, Black AC Jr, et al. Bradycardia following injection of 6-hydroxydopamine into the intermediate portion of nucleus tractus solitarius medialis. Brain Res. 1981;206:415–20. https://doi.org/10.1016/0006-8993(81)90541-2. PMID: 7214141.

    Article  PubMed  Google Scholar 

  127. Talman WT, Perrone MH, Reis DJ. Acute hypertension after the local injection of kainic acid into the nucleus tractus solitarii of rats. Circ Res. 1981;48:292–8. https://doi.org/10.1161/01.res.48.2.292. PMID: 7460203.

    Article  PubMed  Google Scholar 

  128. Schaller BJ, Filis A, Buchfelder M. Detection and prevention of the trigeminocardiac reflex during skull base surgery. Acta Neurochir (Wien). 2007;149:331. https://doi.org/10.1007/s00701-006-1088-7. PMID: 17342380.

    Article  Google Scholar 

  129. Pocock G, Richards CD. Human physiology: the basis of medicine. 3rd ed. Oxford: Oxford University Press; 2006. p. 332. ISBN 978-0-19-856878-0

    Google Scholar 

  130. Tortora G, Derrickson B. Principles of anatomy & physiology. 13th. ed. Wiley; 2011. p. 906–9. ISBN 9780470646083

    Google Scholar 

  131. Hall J. Guyton and Hall textbook of medical physiology. 12th ed. Philadelphia, PA: Saunders/Elsevier; 2011. p. 505–10.

    Google Scholar 

  132. Saladin K. Human anatomy. 3rd ed. McGraw-Hill; 2011. p. 646–7. ISBN 9780071222075.

    Google Scholar 

  133. Koeppen BM, Stanton BA. Berne and levy physiology e-book. Elsevier Health Sciences; 2017. ISBN 9780323523400.

    Google Scholar 

  134. Bianchi AL, Denavit-Saubie M, Champagnat J. Central control of breathing in mammals: neuronal circuitry, membrane properties, and neurotransmitters. Physiol Rev. 1995;75:1–46. https://doi.org/10.1152/physrev.1995.75.1.1. PMID: 7831394.

    Article  PubMed  Google Scholar 

  135. Rekling JC, Feldman JL. Pre-Bötzinger complex and pacemaker neurons: hypothesized site and kernel for respiratory rhythm generation. Annu Rev Physiol. 1998;60:385–405. https://doi.org/10.1146/annurev.physiol.60.1.385. PMID: 9558470.

    Article  PubMed  Google Scholar 

  136. Smith JC, Ellenberger HH, Ballanyi K, Richter DW, Feldman JL. Pre-Bötzinger complex: a brainstem region that may generate respiratory rhythm in mammals. Science. 1991;254(5032):726–9. https://doi.org/10.1126/science.1683005. PMID 1683005.

    Article  PubMed  PubMed Central  Google Scholar 

  137. Dutschmann M, Herbert H. The Kölliker-fuse nucleus mediates the trigeminally induced apnoea in the rat. Neuroreport. 1996;7:1432–6. PMID: 8856692.

    Article  PubMed  Google Scholar 

  138. McCulloch PF, Panneton WM, Gyuenet PG. Barosensitive bulbospinal neurons in the rat rostral ventrolateral medulla (RVLM) mediate the increase in sympathetic tone during nasal stimulation. Neurosci (Abstr). 1998;24:374.

    Google Scholar 

  139. Gieroba ZJ, Blessing WW. Foscontaining neurons in medulla and pons after unilateral stimulation of the afferent abdominal vagus in conscious rabbits. Neuroscience. 1994;59:851–8. https://doi.org/10.1016/0306-4522(94)90289-5. PMID: 7914681.

    Article  PubMed  Google Scholar 

  140. Golanov EV, Reis DJ. Contribution of oxygen-sensitive neurons of the rostral ventrolateral medulla to hypoxic cerebral vasodilatation in the rat. J Physiol. 1996;495:201–16. https://doi.org/10.1113/jphysiol.1996.sp021585. PMID: 8866363.

    Article  PubMed  PubMed Central  Google Scholar 

  141. Schreihofer AM, Guyenet PG. Identification of C1 presympathetic neurons in rat rostral ventrolateral medulla by juxtacellular labeling in vivo. J Comp Neurol. 1997;387:524–36. PMID: 9373011.

    Article  PubMed  Google Scholar 

  142. Song G, Poon CS. Functional and structural models of pontine modulation of mechanoreceptor and chemoreceptor reflexes. Respir Physiol Neurobiol. 2004;143(2–3):281–92. https://doi.org/10.1016/j.resp.2004.05.009. PMID 15519561.

    Article  PubMed  Google Scholar 

  143. Lumb AB, Horncastle E. Pharmacology and physiology for anesthesia. 2nd ed. Foundation and Clinical Application; 2019. p. 586–612. ISBN 978-0-323-48110-6.

    Book  Google Scholar 

  144. Huynh N, Kato T, Rompré PH, Okura K, Saber M, Lanfranchi PA, Montplaisir JY, Lavigne GJ. Sleep bruxism is associated to micro-arousals and an increase in cardiac sympathetic activity. J Sleep Res. 2006;15:339–46. PMID: 16911037.

    Article  PubMed  Google Scholar 

  145. Kato T, Rompre PH, Montplaisir JY, Sessle BJ, Lavigne GJ. Sleep bruxism: an oromotor activity secondary to micro-arousal. J Dent Res. 2001;80:1940–4. https://doi.org/10.1177/00220345010800101501. PMID: 11706956.

    Article  PubMed  Google Scholar 

  146. Meuwly C, Golanov E, Chowdhury T, Erne P, Schaller B. Trigeminal cardiac reflex: new thinking model about the definition based on a literature review. Medicine (Baltimore). 2015;94:e484. PMID: 25654391.

    Article  Google Scholar 

  147. Schames SE, Schames J, Schames M, Chagall-Gungur SS. Sleep bruxism, an autonomic self-regulating response by triggering the trigeminal cardiac reflex. J Calif Dent Assoc. 2012;40:670–1, 674–6. PMID: 22953526.

    PubMed  Google Scholar 

  148. Brunelli M, Coppi E, Tonlorenzi D, Del Seppia C, Lapi D, Colantuoni A, et al. Prolonged hypotensive and bradycardic effects of passive mandibular extension: evidence in normal volunteers. Arch Ital Biol. 2012;150:231–7. PMID: 23479456.

    PubMed  Google Scholar 

  149. Chase MH, Enomoto S, Hiraba K, Katoh M, Nakamura Y, Sahara Y, et al. Role of medullary reticular neurons in the inhibition of trigeminal motoneurons during active sleep. Exp Neurol. 1984;84:364–73. PMID: 6714349.

    Article  PubMed  Google Scholar 

  150. Gastaldo E, Quatrale R, Graziani A, Eleopra R, Tugnoli V, Tola MR, et al. e excitability of the trigeminal motor system in sleep bruxism: a transcranial magnetic stimulation and brainstem re ex study. J Orofac Pain. 2006;20:145–55. PMID: 16708832.

    PubMed  Google Scholar 

  151. Lavigne GJ, Huynh N, Kato T, Okura K, Adachi K, Yao D, Sessle B. Genesis of sleep bruxism: motor and autonomic-cardiac interactions. Arch Oral Biol. 2007;52:381–4. PMID: 17313939.

    Article  PubMed  Google Scholar 

  152. de Paula PM, Tolstykh G, Mifflin S. Chronic intermittent hypoxia alters NMDA and AMPA-evoked currents in NTS neurons receiving carotid body chemoreceptor inputs. Am J Physiol Regul Integr Comp Physiol. 2007;292:2259–65. PMID: 17332161.

    Article  Google Scholar 

  153. Narkiewicz K, Pesek CA, Kato M, Phillips BG, Davison DE, Somers VK. Baroreflex control of sympathetic nerve activity and heart rate in obstructive sleep apnea. Hypertension. 1998;32:1039–43. PMID: 9856970.

    Article  PubMed  Google Scholar 

  154. Narkiewicz K, van de Borne PJH, Montano N, Dyken ME, Phillips BG, Somers VK. Contribution of tonic chemoreflex activation to sympathetic activity and blood pressure in patients with obstructive sleep apnea. Circulation. 1998;97:943–5. PMID: 9529260.

    Article  PubMed  Google Scholar 

  155. Parati G, Di Rienzo M, Bonsignore MR, Insalco G, Marrone O, Cadtiglioni P, Bonsignore G, Mancia G. Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep. J Hypertens. 1997;2:1621–6. PMID: 9488213.

    Article  Google Scholar 

  156. Condos WR Jr, Latham RD, Hoadley SD, Pasipoularides A. Hemodynamics of the Mueller maneuver in man: right and left heart micromanometry and Doppler echocardiography. Circulation. 1987;76:1020–8. PMID: 3664990.

    Article  PubMed  Google Scholar 

  157. Hall MJ, Ando S-I, Floras JS, Bradley TD. Magnitude and time course of hemodynamic responses to Mueller maneuvers in patients with congestive heart failure. J Appl Physiol. 1998;85:1476–84. PMID: 9760344.

    Article  PubMed  Google Scholar 

  158. Franz MR. Mechano-electrical feedback in ventricular myocardium. Cardiovasc Res. 1996;32:15–24. PMID: 8776399.

    Article  PubMed  Google Scholar 

  159. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52:490–4.

    Article  PubMed  Google Scholar 

  160. Simantirakis EN, Schiza SI, Marketou ME, Chysostomakis SI, Chlouverakis GI, Klapsinos NC, Siafakas NS, Vardas PE. Severe bradyarrhythmias in patients with sleep apnoea: the effect of continuous positive airway pressure treatment: a long-term evaluation using an insertable loop recorder. Eur Heart J. 2004;25:1070–6. PMID: 15191779.

    Article  PubMed  Google Scholar 

  161. Jehan S, Farag M, Zizi F, et al. Obstructive sleep apnea and stroke. Sleep Med Disord. 2018;2(5):120–5. PMID: 30680373.

    PubMed  PubMed Central  Google Scholar 

  162. Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med. 2009;180(1):36–41. PMID: 19406983.

    Article  PubMed  Google Scholar 

  163. Munoz R, Cantolla JD, Martínez VE, Gallego J, Rubio R, Aizpuru F, De La Torre G. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke. 2006;37:2317–21. PMID: 16888274.

    Article  PubMed  Google Scholar 

  164. Pialoux V, Hanly PJ, Foster GE, et al. Effects of exposure to intermittent hypoxia on oxidative stress and acute hypoxic ventilatory response in humans. Am J Respir Crit Care Med. 2009;180(10):1002–9. PMID: 19713446.

    Article  PubMed  Google Scholar 

  165. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290(14):1906–14. PMID: 14532320.

    Article  PubMed  Google Scholar 

  166. Towfighi A, Saver JL. Stroke declines from third to fourth leading cause of death in the United States: historical perspective and challenges ahead. Stroke. 2011;42(8):2351–5. PMID: 21778445.

    Article  PubMed  Google Scholar 

  167. Adeseun G, Rosas S. The impact of obstructive sleep apnea of chronic kidney disease. Curr Hypertens Rep. 2010;12(5):378–83. https://doi.org/10.1007/s11906-010-0135-1. PMID: 20676805.

    Article  PubMed  PubMed Central  Google Scholar 

  168. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A, Kales A. Association of hypertension accompanying renal failure. Kidney Int. 1985;28:814–22.

    Article  Google Scholar 

  169. Nieto FJ, Young TB, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AM, Lebowitz MD, Pickering TG. Association of sleep disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Hearth Health Study. JAMA. 2000;283:1829–36.

    Article  PubMed  Google Scholar 

  170. Unruh ML. Sleep apnea and dialysis therapies: things that go bump in the night? Hemodial Int. 2007;11:369–78.

    Article  PubMed  Google Scholar 

  171. Owens L, Inami T, Perger E, Yadollahi A, Chan C, Bradley T. The effect of fluid overload on sleep apnoea severity in haemodialysis patients. Eur Respir J. 2017;49:1601789. https://doi.org/10.1183/13993993.01789-2016. PMID: 28381432.

    Article  Google Scholar 

  172. Coughlin S, Mawdsley L, Mugarza J, Calverley P, Wilding J. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25(9):735–41.

    Article  PubMed  Google Scholar 

  173. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on Detection, Evaluation, and Treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97. PMID: 11368702.

    Article  Google Scholar 

  174. Parish JM, Adam T, Facchiano L. Relationship of metabolic syndrome and obstructive sleep apnea. J Clin Sleep Med. 2007;3(5):467–72. PMID: 17803009.

    Article  PubMed  PubMed Central  Google Scholar 

  175. Dorkova Z, Petrasova D, Molcanyiova A, Popovnakova M, Tkacova R. Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest. 2008;134:686–92. PMID: 18625666.

    Article  PubMed  Google Scholar 

  176. Mota PC, Drummond M, Winck JC, Santos AC, Almeida J, Marques JA. APAP impact on metabolic syndrome in obstructive sleep apnea patients. Sleep Breath. 2011;15(4):665–72. PMID: 20862557.

    Article  PubMed  Google Scholar 

  177. Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115:911–9. PMID: 15867843.

    Article  PubMed  Google Scholar 

  178. Lam JCM, Mak JCW, Ip MSM. Obesity, obstructive sleep apnoea and metabolic syndrome. Respirology. 2012;17:223–36. PMID: 21992649.

    Article  PubMed  Google Scholar 

  179. Kumada M, Kihara S, Sumitsuji S, et al. Association of hypoadiponectinemia with coronary artery disease in men. Arteriocler Thromb Vasc Biol. 2003;23:85–9. PMID: 12524229.

    Article  Google Scholar 

  180. Pischon T, Girman CJ, Hotamisligil GS, et al. Plasma adiponectin levels and risk of myocardial infarction in man. JAMA. 2004;291:1730–7. PMID: 15082700.

    Article  PubMed  Google Scholar 

  181. Makino S, Handa H, Suzukawa K, et al. Obstructive sleep apnoea syndrome, plasma adiponectin levels, and insulin resistance. Clin Endocrinol (Oxf). 2006;64:12–9. PMID: 16402923.

    Article  Google Scholar 

  182. de Lima AM, Franco CM, de Castro CMM, de Andrade Bezerra A, Ataide L Jr, Halpern A. Effects of nasal continuous positive airway pressure treatment on oxidative stress and adiponectin levels in obese patients with obstructive sleep apnea. Respiration. 2010;79:370–6. PMID: 19590157.

    Article  PubMed  Google Scholar 

  183. Lam JC, Xu A, Tam S, Khong P, Yao T, Lam DCL, Lai AYK, Lam B, Lam KSL, Mary SM. Hypoadiponectinemia is related to the sympathetic activity and severity of obstructive sleep apnea. Sleep. 2008;31:1721–7. PMID: 19090328.

    Article  PubMed  PubMed Central  Google Scholar 

  184. McArdle N, Hillman D, Beilin L, Watts G. Metabolic risk factors for vascular disease in obstructive sleep apnea: a matched controlled study. Am J Respir Crit Care Med. 2007;175:190–5. PMID: 17068329.

    Article  PubMed  Google Scholar 

  185. Wolk R, Svatikova A, Nelson CA, Gami AS, Govender K, Winnicki M, Somers VK. Plasma levels of adiponectin, a novel adipocyte-derived hormone, in sleep apnea. Obes Res. 2005;13:186–90. PMID: 15761179.

    Article  PubMed  Google Scholar 

  186. Ahima RS, Saper CB, Flier JS, Elmquist JK. Leptin regulation of neuroendocrine systems. Front Neuroendocrinol. 2000;21:263–307. PMID: 10882542.

    Article  PubMed  Google Scholar 

  187. Considine RV, Sinha MK, Heiman ML, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996;334:292–5. PMID: 8532024.

    Article  PubMed  Google Scholar 

  188. Cuhadaroğlu C, Utkusavaş A, Oztürk L, Salman S, Ece T. Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea. Lung. 2009;187:75–81. PMID: 19127383.

    Article  PubMed  Google Scholar 

  189. Luo JD, Zhang GS, Chen MS. Leptin and cardiovascular diseases. Drug News Perspect. 2005;18:427–31. PMID: 16362081.

    Article  PubMed  Google Scholar 

  190. Pan W, Kastin AJ. Leptin: a biomarker for sleep disorders? Sleep Med Rev. 2014;18(3):283–90. PMID: 24080454.

    Article  PubMed  Google Scholar 

  191. Parhami F, Tintut Y, Ballard A, Demer LL. Leptin enhances the calcification of vascular cells: artery wall as a target of leptin. Circ Res. 2001;88:954–60. PMID: 11349006.

    Article  PubMed  Google Scholar 

  192. Schoeller DA, Cella LK, Sinha MK, Caro JF. Entertainment of the diurnal rhythm of plasma leptin to meal timing. J Clin Invest. 1997;97:1882–7. PMID: 9312190.

    Article  Google Scholar 

  193. Simon C, Gronfier C, Schlienger JL, Brandenberger G. Circadian and ultradian variations of leptin in normal man under continuous enteral nutrition: relationship to sleep and body temperature. J Clin Endocrinol Metab. 1998;83:1893–9. PMID: 9626115.

    Article  PubMed  Google Scholar 

  194. Sinha MK, Ohannesian JP, Heiman ML, Kriauciunas A, Stephans TW, Magosin S, Marco C, Cari JF. Nocturnal rise in leptin in lean, obese, and non-insulin-dependent diabetes mellitus subjects. J Clin Invest. 1996;97:1344–7. PMID: 8636448.

    Article  PubMed  PubMed Central  Google Scholar 

  195. Chihara Y, Akamizu T, Azuma M, Murase K, Harada Y, Tanizawa K, Handa T, Oga T, Mishima M, Kazuo Chin K. Among metabolic factors, significance of fasting and postprandial increases in acyl and desacyl ghrelin and the acyl/desacyl ratio in obstructive sleep apnea before and after treatment. J Clin Sleep Med. 2015;11(8):895–905. PMID: 25845896.

    Article  PubMed  PubMed Central  Google Scholar 

  196. Harsch IA, Konturek PC, Kuehnlein PP, Fuchs FS, Pour Schahin S, Wiest GH, Hahn EG, Lohmann T, Ficker JH. Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment. Eur Respir J. 2003;22(2):251–7. PMID: 12952256.

    Article  PubMed  Google Scholar 

  197. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141:846–50. PMID: 15583226.

    Article  PubMed  Google Scholar 

  198. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. PMID: 15602591.

    Article  PubMed  PubMed Central  Google Scholar 

  199. Tschöp M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML. Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50(4):707–9. PMID: 11289032.

    Article  PubMed  Google Scholar 

  200. Ayetkin E, Demir S, Komut E, Okur SC, Burnaz O, Caglar NS, Demiryontar DY. Chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and the relationship between sleep disorder and pain level, quality of life, and disability. J Phys Ther Sci. 2015;27(9):2951–4. PMID: 26504332.

    Article  Google Scholar 

  201. Okura K, Lavigne GJ, Huynh N, Manzini C, Fillipini D, Montplaisir JY. Comparison of sleep variables between chronic widespread musculoskeletal pain, insomnia, periodic leg movements syndrome and control subjects in a clinical sleep medicine practice. Sleep Med. 2008;9:352–61. PMID: 17804292.

    Article  PubMed  Google Scholar 

  202. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. Natl Health Stat Rep. 2008;8:1–29. PMID: 18958997.

    Google Scholar 

  203. Smith MT, Perlis ML, Smith MS, Giles DE, Carmody TP. Sleep quality and presleep arousal in chronic pain. J Behav Med. 2000;23:1–13. PMID: 10749008.

    Article  PubMed  Google Scholar 

  204. Farney RJ, Walker JM, Boyle KM, Cloward TM, Shilling KC. Adaptive servoventilation (ASV) in patients with sleep disordered breathing associated with chronic opioid medications for non-malignant pain. J Clin Sleep Med. 2008;4:311–9. PMID: 18763421.

    Article  PubMed  PubMed Central  Google Scholar 

  205. American Academy of Sleep Med. International classification of sleep disorders. 3rd ed. Dairen: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  206. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. PMID: 29368949.

    Article  Google Scholar 

  207. Cho SJ, Song TJ, Chu MK. Sleep and tension-type headache. Curr Neurol Neurosci Rep. 2019;19(7):44. PMID: 31144052.

    Article  PubMed  Google Scholar 

  208. Chiu Y, Hu H, Lee F, Huang H. Tension-type headache associated with obstructive sleep apnea: a nationwide population-based study. J Headache Pain. 2015;16:34. PMID: 25896615.

    Article  PubMed  PubMed Central  Google Scholar 

  209. Ferini-Strambi L, Lombardi GE, Marelli S, Galbiati A. Neurological deficits in obstructive sleep apnea. Curr Treat Options Neurol. 2017;19(4):16. PMID: 28374233.

    Article  PubMed  Google Scholar 

  210. Kudrow L, McGinty JD, Phillips ER, Stevenson M. Sleep apnea in cluster headache. Cephalalgia. 1984;4(1):33–8. PMID: 6713522.

    Article  PubMed  Google Scholar 

  211. Gupta M, Simpson F. Obstructive sleep apnea and psychiatric disorders: a systemic review. J Clin Sleep Med. 2015;11(2):165–75. PMID: 25406268.

    Article  PubMed  PubMed Central  Google Scholar 

  212. Lopresti AL, Drummond PD. Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment. Prog Neuropsychopharmacol Biol Psychiatry. 2013;45:92–9. PMID: 23685202.

    Article  PubMed  Google Scholar 

  213. Otero L, del Carmen Figueredo M, Riveros-Rivera A, Hidalgo P. Cognitive impairment and obstructive sleep apnea. IntechOpen. 2019; https://doi.org/10.5772/intechopen.82756.

  214. Andrade A, Bubu O, Varga A, Osorio R. The relationship between obstructive sleep apnea and Alzheimer’s disease. J Alzheimers Dis. 2018;64(Suppl 1):S255–70. PMID: 29782319.

    Article  PubMed  PubMed Central  Google Scholar 

  215. Aviles-Reyes RX, Angelo MF, Villarreal A, Rios H, Lazarowski A, Ramos AJ. Intermittent hypoxia during sleep induces reactive gliosis and limited neuronal death in rats: implications for sleep apnea. J Neurochem. 2010;112:854–69. PMID: 20002528.

    Article  PubMed  Google Scholar 

  216. Baril AA, Gagnon K, Brayet P, Montplaisir J, De Beaumont L, Carrier J, Lafond C, L’Heureux F, Gagnon JF, Gosselin N. Gray matter hypertrophy and thickening with obstructive sleep apnea in middle-aged and older adults. Am J Respir Crit Care Med. 2017;195(11):1509–18. PMID: 28060546.

    Article  PubMed  Google Scholar 

  217. Brown BM, Rainey-Smith SR, Villemagne VL, Weinborn M, Bucks RS, Sohrabi HR, Laws SM, Taddei K, Macaulay SL, Ames D, Fowler C. The relationship between sleep quality and brain amyloid burden. Sleep. 2016;39(5):1063–8. PMID: 27091528.

    Article  PubMed  PubMed Central  Google Scholar 

  218. Kallenberg K, Bailey DM, Christ S, Mohr A, Roukens R, Menold E, Steiner T, Bartsch P, Knauth M. Magnetic resonance imaging evidence of cytotoxic cerebral edema in acute mountain sickness. J Cereb Blood Flow Metab. 2007;27(5):1064–71. PMID: 17024110.

    Article  PubMed  Google Scholar 

  219. Kang JE, Lim MM, Bateman RJ, Lee JJ, Smyth LP, Cirrito JR, Fujiki N, Nishino S, Holtzman DM. Amyloid-β dynamics are regulated by orexin and the sleep-wake cycle. Science. 2009;326:1005–7. PMID: 19779148.

    Article  PubMed  PubMed Central  Google Scholar 

  220. Li RC, Row BW, Kheirandish L, Brittian KR, Gozal E, Guo SZ, Sachleben LR, Gozal D. Nitric oxide synthase and intermittent hypoxia-induced spatial learning deficits in the rat. Neurobiol Dis. 2004;17(1):44–53. PMID: 15350964.

    Article  PubMed  Google Scholar 

  221. Row BW, Liu R, Xu W, Kheirandish L, Gozal D. Intermittent hypoxia is associated with oxidative stress and spatial learning deficits in the rat. Am J Respir Crit Care Med. 2003;167(11):1548–53. PMID: 12615622.

    Article  PubMed  Google Scholar 

  222. Song Y, Blackwell T, Yaffe K, Ancoli-Israel S, Redline S, Stone KL. Relationships between sleep stages and changes in cognitive function in older men: the MrOS Sleep Study. Sleep. 2015;38(3):411–21. PMID: 25325465.

    Article  PubMed  PubMed Central  Google Scholar 

  223. Spira AP, Gamaldo AA, An Y, Wu MN, Simonsick EM, Bilgel M, Zhou Y, Wong DF, Ferrucci L, Resnick SM. Self-reported sleep and β-amyloid deposition in community-dwelling older adults. JAMA Neurol. 2013;70(12):1537–43. PMID: 24145859.

    PubMed  PubMed Central  Google Scholar 

  224. Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O’Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373–7. PMID: 24136970.

    Article  PubMed  Google Scholar 

  225. Xu W, Chi L, Row BW, Xu R, Ke Y, Xu B, Luo C, Kheirandish L, Gozal D, Liu R. Increased oxidative stress is associated with chronic intermittent hypoxia-mediated brain cortical neuronal cell apoptosis in a mouse model of sleep apnea. Neuroscience. 2004;126(2):313–23. PMID: 15207349.

    Article  PubMed  Google Scholar 

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Kim, J., Demerjian, G.G., Patel, M., Barkhordarian, A. (2022). Medical Comorbidities of Obstructive Sleep Apnea. In: Demerjian, G.G., Patel, M., Chiappelli, F., Barkhordarian, A. (eds) Dental Sleep Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-10646-0_5

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