Obstructive sleep apnea (OSA) is a common disease with major cardiovascular and neurocognitive consequences and yet current therapies are unacceptable for some patients. While CPAP (continuous positive airway pressure) can be transformative for some patients, adherence to this treatment is highly variable and alternative therapies suffer from incomplete efficacy. We have recently observed evidence of neuromyopathy in OSA using some newly developed sophisticated electrophysiological techniques. These data have corroborated the findings of other groups showing either sensory or motor impairment of upper airway neuromuscular reflexes in OSA. However, we remain unclear whether the observed findings are indeed clinically important. We plan to define the variability in reinnervation (a marker of nerve injury) in OSA compared to matched controls, also trying to identify predictors of this pattern for clinicians to use. We will further assess the importance of these findings by assessing tongue protrusion force and fatigability as well as the potential impact of neuromyopathy on upper airway mechanics during sleep. We will also conduct a pilot clinical trial to assess the impact of muscle training exercises on OSA patients with and without evidence of reinnervation. Ultimately, we hope that our research will help to define new therapeutic targets at least for a subset of OSA patients.

Public Health Relevance

Statement Sleep apnea patients sometimes have serious complications. Recent evidence suggests that the nerves and muscles controlling the upper airway may be damaged in sleep apnea patients. We will determine how common this problem is, how it affects the function of the airway muscles during wakefulness and sleep and whether it can be treated effectively with muscle training exercises.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
2R01HL085188-05A1
Application #
8698091
Study Section
Respiratory Integrative Biology and Translational Research Study Section (RIBT)
Program Officer
Laposky, Aaron D
Project Start
2006-07-01
Project End
2019-03-31
Budget Start
2014-09-01
Budget End
2015-03-31
Support Year
5
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of California San Diego
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Hepokoski, Mark; Owens, Robert L; Malhotra, Atul et al. (2016) Mechanical ventilation in acute respiratory distress syndrome at ATS 2016: the search for a patient-specific strategy. J Thorac Dis 8:S550-2
Mbanze, Irina; Moschovis, Peter P; Malhotra, Atul (2016) The American Thoracic Society Global Scholars Program. J Thorac Dis 8:S586-7
Lam, Michael T Y; Grandner, Michael A; Malhotra, Atul (2016) Lungs can tell time-a highlight from 2016 ATS session on clock genes, inflammation, immunology, and sleep. J Thorac Dis 8:S579-81
Anderson, Ryan J; Malhotra, Atul; Kim, Nick H (2016) Pulmonary hypertension: evolution of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. J Thorac Dis 8:S562-5
Malhotra, Atul; Liang, Ni-Cheng (2016) Introduction: American Thoracic Society International Meeting 2016. J Thorac Dis 8:S528-9
Zaremba, Sebastian; Shin, Christina H; Hutter, Matthew M et al. (2016) Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery. Anesthesiology 125:92-104
Schorr, Fabiola; Kayamori, Fabiane; Hirata, Raquel P et al. (2016) Different Craniofacial Characteristics Predict Upper Airway Collapsibility in Japanese-Brazilian and White Men. Chest 149:737-46
Truong, Kimberly K; Lam, Michael T; Grandner, Michael A et al. (2016) Timing Matters: Circadian Rhythm in Sepsis, Obstructive Lung Disease, Obstructive Sleep Apnea, and Cancer. Ann Am Thorac Soc 13:1144-54
Jaiswal, Stuti J; Malhotra, Atul; Owens, Robert L (2016) Sleep and critical illness: bridging the two pillars at the ATS 2016. J Thorac Dis 8:S536-8
Malhotra, Atul; Jordan, Amy (2016) The importance of arousal in obstructive sleep apnea-updates from the American Thoracic Society 2016. J Thorac Dis 8:S542-4

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