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Harper RM. Exploring the brain with sleep-related injuries, and fixing it. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad007. [PMID: 37193272 PMCID: PMC10148654 DOI: 10.1093/sleepadvances/zpad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Indexed: 05/18/2023]
Abstract
The focus of my research efforts rests with determining dysfunctional neural systems underlying disorders of sleep, and identifying interventions to overcome those disorders. Aberrant central and physiological control during sleep exerts serious consequences, including disruptions in breathing, motor control, blood pressure, mood, and cognition, and plays a major role in sudden infant death syndrome, congenital central hypoventilation, and sudden unexpected death in epilepsy, among other concerns. The disruptions can be traced to brain structural injury, leading to inappropriate outcomes. Identification of failing systems arose from the assessment of single neuron discharge in intact, freely moving and state-changing human and animal preparations within multiple systems, including serotonergic action and motor control sites. Optical imaging of chemosensitive, blood pressure and other breathing regulatory areas, especially during development, were useful to show integration of regional cellular action in modifying neural output. Identification of damaged neural sites in control and afflicted humans through structural and functional magnetic resonance imaging procedures helped to identify the sources of injury, and the nature of interactions between brain sites that compromise physiological systems and lead to failure. Interventions to overcome flawed regulatory processes were developed, and incorporate noninvasive neuromodulatory means to recruit ancient reflexes or provide peripheral sensory stimulation to assist breathing drive to overcome apnea, reduce the frequency of seizures, and support blood pressure in conditions where a failure to perfuse can lead to death.
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Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Forstenpointner J, Maallo AMS, Elman I, Holmes S, Freeman R, Baron R, Borsook D. The Solitary Nucleus Connectivity to Key Autonomic Regions in Humans MRI and Literature based Considerations. Eur J Neurosci 2022; 56:3938-3966. [PMID: 35545280 DOI: 10.1111/ejn.15691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
The nucleus tractus solitarius (NTS), is a key brainstem structure relaying interoceptive peripheral information to the interrelated brain centers for eliciting rapid autonomic responses and for shaping longer-term neuroendocrine and motor patterns. Structural and functional NTS' connectivity has been extensively investigated in laboratory animals. But there is limited information about NTS' connectome in humans. Using MRI, we examined diffusion and resting state data from 20 healthy participants in the Human Connectome Project. The regions within the brainstem (n=8), subcortical (n=6), cerebellar (n=2) and cortical (n=5) parts of the brain were selected via a systematic review of the literature and their white matter NTS connections were evaluated via probabilistic tractography along with functional and directional (i.e., Granger-causality) analyses. The underlying study confirms previous results from animal models and provides novel aspects on NTS integration in humans. Two key findings can be summarized: (i) the NTS predominantly processes afferent input and (ii) a lateralization towards a predominantly left-sided NTS processing. Our results lay the foundations for future investigations into the NTS' tripartite role comprised of interoreceptors' input integration, the resultant neurochemical outflow and cognitive/affective processing. The implications of these data add to the understanding of NTS' role in specific aspects of autonomic functions.
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Affiliation(s)
- Julia Forstenpointner
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne Margarette S Maallo
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Igor Elman
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Scott Holmes
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Department of Radiology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Pal A, Ogren JA, Aguila AP, Aysola R, Kumar R, Henderson LA, Harper RM, Macey PM. Functional organization of the insula in men and women with obstructive sleep apnea during Valsalva. Sleep 2021; 44:5864015. [PMID: 32592491 DOI: 10.1093/sleep/zsaa124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/11/2020] [Indexed: 12/26/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) patients show impaired autonomic regulation, perhaps related to functional reorganization of the insula, which in healthy individuals shows sex-specific anterior and right dominance during sympathetic activation. We examined insular organization of responses to a Valsalva maneuver in OSA with functional magnetic resonance imaging (fMRI). METHODS We studied 43 newly diagnosed OSA (age mean ± SD: 46.8 ± 8.7 years; apnea-hypopnea index (AHI) ± SD: 32.1 ± 20.1 events/hour; 34 males) and 63 healthy (47.2 ± 8.8 years; 40 males) participants. Participants performed four 18-second Valsalva maneuvers (1-minute intervals, pressure ≥ 30 mmHg) during scanning. fMRI time trends from five insular gyri-anterior short (ASG); mid short (MSG); posterior short (PSG); anterior long (ALG); and posterior long (PLG)-were assessed for within-group responses and between-group differences with repeated measures ANOVA (p < 0.05); age and resting heart rate (HR) influences were also assessed. RESULTS Right and anterior fMRI signal dominance appeared in OSA and controls, with no between-group differences. Separation by sex revealed group differences. Left ASG anterior signal dominance was lower in OSA versus control males. Left ASG and ALG anterior dominance was higher in OSA versus control females. In all right gyri, only OSA females showed greater anterior dominance than controls. Right dominance was apparent in PSG and ALG in all groups; females showed right dominance in MSG and PLG. OSA males did not show PLG right dominance. Responses were influenced substantially by HR but modestly by age. CONCLUSIONS Anterior and right insular fMRI dominance appears similar in OSA versus control participants during the sympathetic phase of the Valsalva maneuver. OSA and control similarities were present in just males, but not necessarily females, which may reflect sex-specific neural injury.
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Affiliation(s)
- Amrita Pal
- UCLA School of Nursing, University of California, Los Angeles, CA
| | - Jennifer A Ogren
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Andrea P Aguila
- UCLA School of Nursing, University of California, Los Angeles, CA
| | - Ravi Aysola
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Luke A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Paul M Macey
- UCLA School of Nursing, University of California, Los Angeles, CA
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Peng L, Wang J, Zhang L, Liu P, Wang M, Huang M, Liu S, He P, Cui L, Li M, Wang S. Role of 5-hydroxytryptamine expression in cerebellar Purkinje cells in obstructive sleep apnea syndrome. Neural Regen Res 2012; 7:606-10. [PMID: 25745452 PMCID: PMC4346986 DOI: 10.3969/j.issn.1673-5374.2012.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/20/2011] [Indexed: 11/18/2022] Open
Abstract
In the present study, electrical stimulation to the rat insular cortex induced apnea or respiratory disturbance, reduced amplitude of genioglossal electromyogram, and decreased electromyogram integrals. In addition, arterial blood gas analysis showed arterial blood acidosis, reduced pH values, increased alkali reserve negative values, decreased peripheral blood 5-hydroxytryptamine content, and increased 5-hydroxytryptamine expression in cerebellar Purkinje cells. Following lidocaine injection to block the habenular nucleus, abnormalities in breath, genioglossal electromyogram, and blood gas values disappeared, and peripheral blood 5-hydroxytryptamine content returned to levels prior to electric stimulation. However, 5-hydroxytryptamine expression in cerebellar Purkinje cells remained high. The results suggested that 5-hydroxytryptamine expression in Purkinje cells did not correlate with ventilation function involving insular cortex and habenular nucleus.
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Affiliation(s)
- Liping Peng
- Department of Pneumology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jinghua Wang
- Department of Pneumology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Lihong Zhang
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun 130021, Jilin Province, China
| | - Pan Liu
- Department of Pneumology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Min Wang
- Department of Pneumology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Min Huang
- Department of Physiology, Norman Bethune College of Medicine, Jilin University, Changchun 130021, Jilin Province, China
| | - Shengnan Liu
- Department of Pneumology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Pingping He
- Department of Pneumology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Li Cui
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Mingxian Li
- Department of Pneumology, First Affiliated Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Shao Wang
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun 130021, Jilin Province, China
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Zhang X, Chen X, Yu Y, Sun D, Ma N, He S, Hu X, Zhang D. Masked smoking-related images modulate brain activity in smokers. Hum Brain Mapp 2009; 30:896-907. [PMID: 18344177 DOI: 10.1002/hbm.20552] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The questions of whether and how indiscriminate drug-related stimuli could influence drug-users are important to our understanding of addictive behavior, but the answers are still inconclusive. In the present preliminary functional magnetic resonance imaging study using a backward masking paradigm, the effect of indiscriminate smoking-related stimuli on 10 smokers and 10 nonsmokers was examined. The BOLD response showed a significant reduction (P = 0.001) in the right amygdala of smokers when they viewed but did not perceive masked smoking-related stimuli, while no significant differences were found in the nonsmoker group. More voxels in anterior cingulate cortex were negatively correlated with the amygdala during the masked smoking-related picture condition in smokers but not in nonsmokers, whereas more positively correlated voxels were observed during the masked neutral condition. The BOLD response in drug-users indicates the amygdala responds to drug-related stimuli that are below the perceptual threshold. The functional connectivity data suggest a functional interaction between the amygdala and the anterior cingulate cortex when drug users view 33 ms back-masked drug-related stimuli. This observation suggests that the amygdala plays an important role in the indiscriminate drug-related cue process.
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Affiliation(s)
- Xiaochu Zhang
- Hefei National Laboratory for Physical Science at Microscale and School of Life Science, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
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Kinney HC, Belliveau RA, Trachtenberg FL, Rava LA, Paterson DS. The development of the medullary serotonergic system in early human life. Auton Neurosci 2007; 132:81-102. [PMID: 17236817 DOI: 10.1016/j.autneu.2006.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 10/13/2006] [Accepted: 11/08/2006] [Indexed: 11/16/2022]
Abstract
The serotonergic (5-HT) neurons of the medulla oblongata are postulated to comprise a system that modulates homeostatic function in response to metabolic imbalances in the internal milieu in a state-dependent manner. In this study, we define the baseline development of the topography of the human medullary 5-HT system in 30 cases ranging from the embryonic period through infancy. We used immunocytochemical techniques with the PH8 antibody which recognizes the key 5-HT synthetic enzyme, tryptophan hydroxylase, and computer-based methods of cell quantitation. In the infant medulla, 5-HT neurons were distributed in raphé, extra-raphé, and ventral positions that place these neurons adjacent to, or intermingled with, the neurons in the lower cranial nerve nuclei and reticular formation that directly mediate respiration, upper airway reflexes, and autonomic function. Along the ventral and ventrolateral surface, 5-HT neurons formed two lateral and one midline "columns" in the rostrocaudal axis that are homologous in position to chemosensitive 5-HT neurons in rats, and that correspond in part to the classic respiratory chemosensitive fields. Serotonergic neurons comprised a subpopulation of the arcuate nucleus along the ventral surface; their short processes directly abutted the surface, suggesting a role for them in monitoring carbon dioxide levels in the cerebrospinal fluid. The medullary 5-HT system began to form in the embryo, with the raphé primordia appearing as early as 7 weeks (the earliest time-point available). By 10-12 weeks, the lateral tegmental 5-HT neurons clustered into the early primordia of extra-raphé subnuclei. By 20 weeks, the "adult-like" topography of the medullary 5-HT system was in place, with subtle (quantitative) changes occurring thereafter. Thus, protracted changes occur from the prenatal period through infancy. These data provide a foundation for 5-HT neuronal analysis in pediatric brainstem disorders, as proposed in the sudden infant death syndrome.
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Affiliation(s)
- Hannah C Kinney
- Department of Pathology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Kopczyńska B, Szereda-Przestaszewska M. 5HT2 and 5HT3 receptors' contribution to modeling of post-serotonin respiratory pattern in cats. Life Sci 2004; 75:2281-90. [PMID: 15350826 DOI: 10.1016/j.lfs.2004.03.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Accepted: 03/18/2004] [Indexed: 11/18/2022]
Abstract
Cardio-respiratory reflex effects of an exogenous serotonin challenge are suggested to be modulated by activation of the peripheral 5HT2 and 5HT3 receptors. In the present experiments the blocking effects of serotoninergic active drugs: ketanserin and tropanserin (MDL 72222) were studied in six pentobarbitone-chloralose anaesthetized cats. Bolus injection of serotonin (0.05 mg.kg(-1)) into the right femoral vein evoked prompt apnea, hypotension followed by tachypnoeic breathing. Pre-treatment with ketanserin (0.1 mg.kg(-1)), 5HT2 receptor antagonist, shortened the duration of post-serotonin apnea (P < 0.05), but had no effect on the pattern of post-apnoeic breathing. 5HT3 receptor blockade with the selective antagonist MDL 72222 (0.2 mg.kg(-1)) totally eliminated respiratory response to serotonin. In breaths that followed post-serotonin apnea, peak amplitude of the integrated phrenic signal was reduced (P < 0.001), unbiased by ketanserin blockade, and remained at the baseline level in MDL treated rats. Serotonin-induced hypotension was unaffected by the blockade of 5HT2 receptors. Inactivation of 5HT3 receptors with MDL attenuated the fall in blood pressure (P < 0.05). This data suggests that the squeal of serotonin-induced pulmonary chemoreflex, i.e. respiratory arrest, post-apnoeic pattern of breathing, bradycardia, and partially hypotension are mediated by 5HT3 receptors.
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MESH Headings
- Animals
- Apnea/physiopathology
- Blood Pressure/drug effects
- Blood Pressure/physiology
- Bradycardia/physiopathology
- Cats
- Dose-Response Relationship, Drug
- Injections, Intraperitoneal
- Ketanserin/pharmacology
- Larynx/physiopathology
- Male
- Phrenic Nerve/physiology
- Receptors, Serotonin, 5-HT2/drug effects
- Receptors, Serotonin, 5-HT2/physiology
- Receptors, Serotonin, 5-HT3/drug effects
- Receptors, Serotonin, 5-HT3/physiology
- Respiratory Mechanics/physiology
- Serotonin/physiology
- Serotonin Antagonists/pharmacology
- Tidal Volume/drug effects
- Tropanes/pharmacology
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Affiliation(s)
- Beata Kopczyńska
- Laboratory of Respiration Physiology, PAS Medical Research Center, 5 Pawiñskiego St., 02-106 Warsaw, Poland.
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Rosa-Neto P, Olsen AK, Gjedde A, Watanabe H, Cumming P. MDMA-evoked changes in cerebral blood flow in living porcine brain: Correlation with hyperthermia. Synapse 2004; 53:214-21. [PMID: 15266553 DOI: 10.1002/syn.20052] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
3,4-Methylenedioxymethamphetamine (MDMA) acutely releases intraneuronal dopamine and serotonin and evokes hyperthermia which is linked to toxicity for serotonin fibers. The acute effects of MDMA on cerebral blood flow (CBF) in living brain have not been described in an animal model of MDMA intoxication. We predicted that MDMA-induced hyperthermia should correlate with increased CBF in the hypothalamus, a serotonin-rich brain region subserving thermoregulation. To test this prediction, we used positron emission tomography with statistical parametric mapping for exploratory analysis of the focal changes in the magnitude of CBF in the anesthetized female Landrace pig (n = 9) at 30 and 150 min after acute challenge with MDMA-HCl (1 mg/kg, i.v.). The MDMA treatment was followed by increased CBF in the occipital cortex and in the medial mesencephalon overlapping the dorsal raphé nucleus, and reduced CBF in the cerebellar vermis and in a cluster in the medulla encompassing the left locus coeruleus. The individual increase of body temperature correlated positively with increased CBF in the vicinity of the raphé nucleus, in the hypothalamus (regions linked to thermoregulation), and also in the medial frontal cortex, which together comprise the regions receiving the most dense serotonin innervations in pig brain. Thus, individual differences in the susceptibility to MDMA-induced hyperthermia in this population correlated with the magnitude of focal increases in CBF within specific brain regions endowed with a dense serotonin innervation, including regions linked to thermoregulation.
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Affiliation(s)
- Pedro Rosa-Neto
- Center for Functionally Integrative Neuroscience, Aarhus University and PET Center, Aarhus University Hospitals, Aarhus C, 8000, Denmark.
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Krakow B, Melendrez D, Warner TD, Dorin R, Harper R, Hollifield M. To breathe, perchance to sleep: sleep-disordered breathing and chronic insomnia among trauma survivors. Sleep Breath 2002; 6:189-202. [PMID: 12524572 DOI: 10.1007/s11325-002-0189-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Standard psychiatric classification (DSM-IV-TR) traditionally attributes post-traumatic sleep disturbance to a secondary or symptomatic feature of a primary psychiatric disorder. The DSM-IV-TR paradigm, however, has not been validated with objective sleep assessment technology, incorporated nosological constructs from the field of sleep disorders medicine, or adequately addressed the potential for post-traumatic stress disorder (PTSD) sleep problems to manifest as primary, physical disorders, requiring independent medical assessments and therapies. This paradigm may limit understanding of sleep problems in PTSD by promulgating such terms as "insomnia related to another mental disorder," a.k.a. "psychiatric insomnia." Emerging evidence invites a broader comorbidity perspective, based on recent findings that post-traumatic sleep disturbance frequently manifests with the combination of insomnia and a higher-than-expected prevalence of sleep-disordered breathing (SDB). In this model of complex sleep disturbance, the underlying sleep pathophysiology interacts with PTSD and related psychiatric distress; and this relationship appears very important as demonstrated by improvement in insomnia, nightmares, and post-traumatic stress with successful SDB treatment, independent of psychiatric interventions. Continuous positive airway pressure treatment in PTSD patients with SDB reduced electroencephalographic arousals and sleep fragmentation, which are usually attributed to central nervous system or psychophysiological processes. Related findings and clinical experience suggest that other types of chronic insomnia may also be related to SDB. We hypothesize that an arousal-based mechanism, perhaps initiated by post-traumatic stress and/or chronic insomnia, may promote the development of SDB in a trauma survivor and perhaps other patients with chronic insomnia. We discuss potential neurohormonal pathways and neuroanatomatical sites that may be involved in this proposed interaction between insomnia and SDB.
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Affiliation(s)
- Barry Krakow
- Sleep and Human Health Institute, Albuquerque, New Mexico 87109, USA.
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Current awareness in NMR in biomedicine. NMR IN BIOMEDICINE 2002; 15:305-312. [PMID: 12112613 DOI: 10.1002/nbm.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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