Obstructive sleep apnea (OSA) is recurrent upper airway obstruction caused by a loss of upper airway muscle tone during sleep, which leads to intermittent hypoxia and sleep fragmentation. OSA is a common disorder affecting 25-30% of adult population and a major cause of cardiovascular morbidity and mortality. Continuous positive airway pressure relieves OSA, but poor adherence severely limits its use. There is an urgent need for alternative therapies that reverse neuromuscular defects in upper airway function. The upper airway patency is regulated by lingual protrudors, including the biggest upper airway dilator, the genioglossus (GG) muscle, but both protrudors and retractors may act synergistically to stabilize the upper airway during sleep. The development of therapeutic strategies has been hindered by the lack of knowledge about the role of different tongue muscles in the pathogenesis of OSA, since methods to manipulate these muscles selectively have not hitherto been available. We have demonstrated that mouse upper airway physiology is identical to humans and that obese mice develop OSA. We will use our mouse model of OSA and other novel investigative tools, i.e. chemogenetics and dynamic magnetic resonance imaging (MRI), to examine the impact of specific hypoglossal motor neurons innervating lingual protrudor and retractor muscles on pharyngeal patency and obstructive sleep apnea. Our proposal utilizes a novel chemogenetic approach for targeting specific motor neuron populations selectively with designer receptors exclusively activated by designer drugs (DREADDs). Excitatory and inhibitory DREADDs will be used to address the main hypothesis that stimulation of specific populations of hypoglossal motor neurons is both necessary and sufficient to stabilize pharyngeal patency and treat OSA.
Specific Aim 1 and 2 will examine the role of different populations of hypoglossal motor neurons in maintaining upper airway patency and the development of OSA. We hypothesize that (A) chemogenetic stimulation of GG fibers in isolation OR in combination with retractor muscles will increase patency of the upper airway and treat OSA, whereas (B) chemogenetic inhibition will decrease airway patency and induce OSA. Cre-dependent DREADDs will be deployed in the hypoglossal nucleus and selectively expressed in motor neurons innervating tongue protrudors alone OR protrudors and retractors using Cre-recombinase administered with a retrograde neuronal vector.
In Specific Aim 1, dynamic MRI will be performed before and after motor neuron manipulation by a DREADD specific ligand, clozapine-N- oxide (CNO), in lean and obese male and female mice.
In Specific Aim 2, sleep studies will be performed with or without DREADD activation by CNO to identify the effect of chemogenetic manipulation of different motor neuron pools on sleep apnea during NREM and REM sleep. The proposal will focus future therapeutic strategies on specific hypoglossal motor neurons for electrical and pharmacological stimulation.

Public Health Relevance

Obstructive sleep apnea, a recurrent upper airway obstruction caused by a loss of upper airway muscle tone during sleep, does not have effective treatment, except poorly tolerated continuous positive airway pressure. We will determine which tongue muscles protect against sleep apnea in our mouse model by deploying designer receptors exclusively activated by designer drugs in neurons innervating different tongue muscles and then stimulating these receptors. Our proposal will identify specific neurons as therapeutic targets in obstructive sleep apnea.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Brown, Marishka
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Fleury Curado, Thomaz; Berger, Slava; Polotsky, Vsevolod Y (2018) Pharmacotherapy of Obstructive Sleep Apnea: Is Salvation Just Around a Corner? Am J Respir Crit Care Med :
Pham, Luu V; Schwartz, Alan R; Polotsky, Vsevolod Y (2018) Integrating loop gain into the understanding of obstructive sleep apnoea mechanisms. J Physiol 596:3819-3820
Fleury Curado, Thomaz; Pho, Huy; Berger, Slava et al. (2018) Sleep-disordered breathing in C57BL/6J mice with diet-induced obesity. Sleep 41:
Berger, Slava; Pho, Huy; Fleury-Curado, Thomaz et al. (2018) Intranasal Leptin Relieves Sleep Disordered Breathing in Mice with Diet Induced Obesity. Am J Respir Crit Care Med :
Berger, Slava; Polotsky, Vsevolod Y (2018) Leptin and Leptin Resistance in the Pathogenesis of Obstructive Sleep Apnea: A Possible Link to Oxidative Stress and Cardiovascular Complications. Oxid Med Cell Longev 2018:5137947
Fleury Curado, Thomaz; Oliven, Arie; Sennes, Luiz U et al. (2018) Neurostimulation Treatment of OSA. Chest 154:1435-1447
Fleury Curado, Thomaz A; Pho, Huy; Dergacheva, Olga et al. (2018) Silencing of Hypoglossal Motoneurons Leads to Sleep Disordered Breathing in Lean Mice. Front Neurol 9:962
Ayas, Najib T; Drager, Luciano F; Morrell, Mary J et al. (2017) Update in Sleep-disordered Breathing 2016. Am J Respir Crit Care Med 195:1561-1566
Fleury Curado, Thomaz; Fishbein, Kenneth; Pho, Huy et al. (2017) Chemogenetic stimulation of the hypoglossal neurons improves upper airway patency. Sci Rep 7:44392
Jun, Jonathan C; Polotsky, Vsevolod Y (2016) Stressful sleep. Eur Respir J 47:366-8