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Lanza G, Fisicaro F, Cantone M, Pennisi M, Cosentino FII, Lanuzza B, Tripodi M, Bella R, Paulus W, Ferri R. Repetitive transcranial magnetic stimulation in primary sleep disorders. Sleep Med Rev 2023; 67:101735. [PMID: 36563570 DOI: 10.1016/j.smrv.2022.101735] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a widely used non-invasive neuromodulatory technique. When applied in sleep medicine, the main hypothesis explaining its effects concerns the modulation of synaptic plasticity and the strength of connections between the brain areas involved in sleep disorders. Recently, there has been a significant increase in the publication of rTMS studies in primary sleep disorders. A multi-database-based search converges on the evidence that rTMS is safe and feasible in chronic insomnia, obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), and sleep deprivation-related cognitive deficits, whereas limited or no data are available for narcolepsy, sleep bruxism, and REM sleep behavior disorder. Regarding efficacy, the stimulation of the dorsolateral prefrontal cortex bilaterally, right parietal cortex, and dominant primary motor cortex (M1) in insomnia, as well as the stimulation of M1 leg area bilaterally, left primary somatosensory cortex, and left M1 in RLS reduced subjective symptoms and severity scale scores, with effects lasting for up to weeks; conversely, no relevant effect was observed in OSAS and narcolepsy. Nevertheless, several limitations especially regarding the stimulation protocols need to be considered. This review should be viewed as a step towards the further contribution of individually tailored neuromodulatory techniques for sleep disorders.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Mariagiovanna Cantone
- Neurology Unit, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy; Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Bartolo Lanuzza
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mariangela Tripodi
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
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Attali V, Weber M, Rivals I, Similowski T, Arnulf I, Gatignol P. Moderate-to-severe obstructive sleep apnea syndrome is associated with altered tongue motion during wakefulness. Eur Arch Otorhinolaryngol 2023; 280:2551-2560. [PMID: 36707431 DOI: 10.1007/s00405-023-07854-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Impairment of genioglossus control is a frequent "non-anatomical" cause of obstructive sleep apnea syndrome (OSAS) in non- or mildly obese patients. Although wake-related compensatory mechanisms prevent the occurrence of obstructive events, the genioglossus control is often impaired during wakefulness. We hypothesized that the lingual motion would be altered during wakefulness in this population in patients with moderate-to-severe OSAS. METHODS We included non- or mildly obese participants with suspected OSAS. They underwent a Bucco-Linguo-Facial Motor Skills assessment using the MBLF ("Motricité Bucco-Linguo-Faciale"), which includes an evaluation of 13 movements of the tongue. This was followed by a night-attended polysomnography. We compared patients with moderate-to-severe OSAS (apnea-hypopnea index (AHI) ≥ 15/h; n = 15) to patients without or with mild OSAS (AHI < 15/h; n = 24). RESULTS MBLF total and "tongue" sub-scores were lower in patients with moderate-to-severe OSAS: total z-score - 0.78 [- 1.31; 0.103] versus 0.20 [- 0.26; 0.31], p = 0.0011; "tongue" z-sub-score (- 0.63 [- 1.83; 0.41] versus 0.35 [0.26; 0.48], p = 0.014). There was a significant age-adjusted correlation between the "tongue" sub-score and AHI. The logistic regression model for the prediction of moderate-to-severe OSAS gave area under the curve ratio of 88.2% for MBLF score plus age. CONCLUSIONS Myofunctional activity of the tongue is impaired during wakefulness in non- or mildly obese patients with moderate-to-severe OSAS. This study supports the lingual myofunctional assessment using the MBLF in screening of moderate-to-severe OSAS. This simple tool could help clinicians to select patients with suspected moderate-to-severe OSAS for polysomnography.
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Affiliation(s)
- Valérie Attali
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France. .,Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| | - Mathilde Weber
- Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département R3S, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Isabelle Arnulf
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institut du Cerveau, Paris Brain Institute-ICM, INSERM, CNRS, Sorbonne Université, 75013, Paris, France
| | - Peggy Gatignol
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France.,Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
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Xie L, Wu Q, Hu W, Wu X, Xiang G, Hao S, Guo H, Li S. Impact of histaminergic H3 receptor antagonist on hypoglossal nucleus in chronic intermittent hypoxia conditions. Psychopharmacology (Berl) 2021; 238:121-131. [PMID: 32964244 DOI: 10.1007/s00213-020-05663-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE The hypoglossal nucleus (HN) controls the movement of the genioglossus (GG) muscle whose dysfunction leads to airway occlusion and occurrence of obstructive sleep apnea (OSA). Histamine produced by the tuberomammillary nucleus (TMN) has a potent excitatory action on GG muscle activity. OBJECTIVES The aim of the study was to investigate the role histaminergic neurons play in the regulation of the genioglossus. METHODS C57BL/6 mice were exposed to chronic intermittent hypoxia (CIH) for 3 weeks to resemble OSA. The histamine H3 receptor (H3R) antagonist ciproxifan was applied to increase histamine in the brain. Histamine levels and GG activity were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and electromyogram (EMG) separately. Neuronal activity and repair ability of the HN and TMN and key proteins of histamine were analyzed by immunohistochemistry and western blots. RESULTS Significant decline of histamine level and GG activity of the HN and TMN induced by CIH exposure could be ameliorated by ciproxifan. Application of ciproxifan could also partly reverse the decline of the histidine decarboxylase (HDC) by CIH. CONCLUSIONS This investigation studied the impacts of ciproxifan on the HN and TMN in CIH conditions and revealed that the negative effects on the HN and TMN caused by CIH could be partly ameliorated by ciproxifan, which might open new perspectives for the development of pharmacological treatment for OSA.
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Affiliation(s)
- Liang Xie
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinhan Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiping Hu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guiling Xiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengyu Hao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Han Guo
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China.
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China.
- Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.
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Huang H, Li W, Jin H, Zhang L, Wei Z, Wang W. Tongue Strength Training Increases Daytime Upper Airway Stability in Rats. Nat Sci Sleep 2021; 13:1653-1661. [PMID: 34588832 PMCID: PMC8473720 DOI: 10.2147/nss.s328214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Tongue strength training (TST) has been shown to decrease the apnea-hypopnea index in some patients with obstructive sleep apnea (OSA). However, whether TST modulates the central regulation of genioglossus and influences the stability of the upper airway remains unknown. The purpose of this study was to dynamically assess the effect of TST on the upper airway. METHODS Sixteen adult male Sprague-Dawley rats were studied to explore the mechanism of TST improving the upper airway function. The rats were randomly assigned to the normal control (NC) and TST groups. The TST group underwent 8-week progressive resistance tongue exercise training. Transcranial magnetic stimulation (TMS) responses and EMG activities were consistently recorded for 2 h on days 0, 14, 28, and 56 of the experiments in both groups. Theoretical critical pressure (Pcrit) value was measured on days 0, 14, 28, and 56. RESULTS The TST group showed shorter TMS latency and higher genioglossus EMG activity, which lasted from 5 min to 80 min after training on day 56 of training, than the NC group. The TST group showed significantly lower theoretical Pcrit values on days 28 and 56 of training than the NC group (-4.07±0.92 vs -3.12±0.77 cmH2O, P< 0.05, -4.66±0.74 vs -3.07±0.38 cmH2O, P< 0.01). CONCLUSION This study revealed that an 8-week TST could gradually and transiently increase corticomotor excitability of genioglossus, elevate the genioglossus EMG activity, and ultimately enhance the stability of the upper airway during daytime. Moreover, improved neuromuscular excitability occurred prior to the enhanced upper airway stability. These findings provide a theoretical foundation for TST as a promising treatment for OSA patients.
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Affiliation(s)
- Hong Huang
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wenyang Li
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Hongyu Jin
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lei Zhang
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhijing Wei
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wei Wang
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
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Elnemr R, Sweed RA, Shafiek H. Diaphragmatic motor cortex hyperexcitability in patients with chronic obstructive pulmonary disease. PLoS One 2019; 14:e0217886. [PMID: 31851669 PMCID: PMC6919588 DOI: 10.1371/journal.pone.0217886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background and objectives Respiratory muscles dysfunction has been reported in COPD. Transcranial magnetic stimulation (TMS) has been used for assessing the respiratory corticospinal pathways particularly of diaphragm. We aimed to study the cortico-diaphragmatic motor system changes in COPD using TMS and to correlate the findings with the pulmonary function. Methods A case control study recruited 30 stable COPD from the out-patient respiratory clinic of Main Alexandria University hospital- Egypt and 17 healthy control subjects who were subjected to spirometry. Cortical conduction of the diaphragm was performed by TMS to all participants followed by cervical magnetic stimulation of the phrenic nerve roots. Diaphragmatic resting motor threshold (DRMT), cortical motor evoked potential latency (CMEPL), CMEP amplitude (CMEPA), peripheral motor evoked potential latency (PMEPL), PMEP amplitude (PMEPA) and central motor conduction time (CMCT) were measured. Results 66.7% of COPD patients had severe and very severe COPD with median age of 59 (55–63) years. There was statistically significant bilateral decrease in DRMT, CMEPA and PMEPA in COPD group versus healthy subjects and significant increase in CMEPL and PMEPL (p <0.01). Left CMCT was significantly prolonged in COPD group versus healthy subjects (p <0.0001) but not right CMCT. Further, there was significant increase in CMEPL and CMCT of left versus right diaphragm in COPD group (p = 0.003 and 0.001 respectively) that inversely correlated with FEV1% and FVC% predicted. Right and left DRMT were insignificantly different in COPD group (p >0.05) but positively correlated with FEV1/FVC, FEV1% and FVC% predicted. Conclusion Central cortico-diaphragmatic motor system is affected in COPD patients with heterogeneity of both sides that is correlated with pulmonary function. Significance Coticospinal pathway affection could be a factor for development of diaphragmatic dysfunction in COPD patients accordingly its evaluation could help in personalization of COPD management especially pulmonary rehabilitation programs.
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Affiliation(s)
- Rehab Elnemr
- Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- * E-mail:
| | - Rania Ahmad Sweed
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hanaa Shafiek
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Launois C, Nierat M, Attali V, Raux M, Arnulf I, Similowski T, Redolfi S. Postural preinspiratory cortical activity, genioglossus activity and fluid shift in awake obstructive sleep apnoea patients. Exp Physiol 2019; 105:370-378. [DOI: 10.1113/ep087804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et Réanimation Département R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
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Leacy JK, O'Halloran KD. Cortical control of upper airway calibre: It's the thought that counts! Exp Physiol 2019; 104:789-790. [DOI: 10.1113/ep087681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Jack K. Leacy
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork Ireland
| | - Ken D. O'Halloran
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork Ireland
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Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dubé BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich R, Rossi A, Series F, Similowski T, Spengler C, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53:13993003.01214-2018. [DOI: 10.1183/13993003.01214-2018] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.
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Launois C, Perger E, Attali V, Nierat M, Raux M, Arnulf I, Similowski T, Redolfi S. Postural respiratory‐related cortical activation and rostral fluid shift in awake healthy humans. Exp Physiol 2019; 104:887-895. [DOI: 10.1113/ep087468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Elisa Perger
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et RéanimationDépartement R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
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Li WY, Wang A, Jin H, Zou Y, Wang Z, Wang W, Kang J. Transient upregulation of TASK-1 expression in the hypoglossal nucleus during chronic intermittent hypoxia is reduced by serotonin 2A receptor antagonist. J Cell Physiol 2019; 234:17886-17895. [PMID: 30864194 DOI: 10.1002/jcp.28419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 11/11/2022]
Abstract
Hypoglossal motoneurons innervate genioglossus muscle, the contraction of which is critical in the maintenance of upper airway patency in patients with obstructive sleep apnea. As a potassium channel distributed in hypoglossal motoneurons, TWIK-related acid-sensitive K+ channel-1 (TASK-1) could be inhibited by 5-HT. This study aimed to investigate if TASK-1 expression in hypoglossal nucleus could be influenced by chronic intermittent hypoxia (CIH) and 5-HT2A receptors antagonist. Two hundred twenty-eight rats were exposed to CIH or normoxia (NO) in the presence and absence of 5-HT 2A receptor antagonist (MDL-100907) microinjected into the hypoglossal nucleus. The expression of 5-HT and TASK-1 in the hypoglossal nucleus were detected by immunohistochemistry and reverse transcription quantitative polymerase chain reaction on the 1st, 3rd, 7th, 14th and 21st day of CIH exposure. The mean optical density (MOD) of 5-HT in the XII nucleus was significantly increased in the CIH and CIH + MDL group than the NO group on the 7th and 21st day ( p < 0.05). Compared with the NO group, the MOD and gene expression of TASK-1 in the CIH group was significantly increased on the 7th and 14th day ( p < 0.05), then normalized on the 21st day. The TASK-1 expression in the CIH + MDL group was significantly lower than the CIH + PBS and CIH group on the 7th and 14th day ( p < 0.05). The CIH-induced transiently upregulation of the TASK-1 expression in the hypoglossal nucleus could be reversed by 5-HT 2A receptor antagonist, indicating that the modulation of the TASK-1 expression in response to CIH involves 5-HT and 5-HT 2A receptors, and this CIH effect might be 5-HT 2A receptor-dependent.
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Affiliation(s)
- Wen-Yang Li
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Aidi Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongyu Jin
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Zou
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zanfeng Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Kang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Attali V, Collet JM, Jacq O, Souchet S, Arnulf I, Rivals I, Kerbrat JB, Goudot P, Morelot-Panzini C, Similowski T. Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome. Respir Physiol Neurobiol 2019; 263:47-54. [PMID: 30872167 DOI: 10.1016/j.resp.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD). Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD. None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p = 0.007). MAD-induced change in awake Pcrit was correlated to VAS-3. In conclusion, MAD revealed "latent dyspnea" related to the severity of upper airways mechanics abnormalities in OSAS patients.
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Affiliation(s)
- Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France.
| | - Olivier Jacq
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Sandie Souchet
- Université Paris I - Panthéon-Sorbonne, laboratoire SAMM (Statistique, Analyse, Modélisation Multidisciplinaire -EA4543), F-75005, Paris, France.
| | - Isabelle Arnulf
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Isabelle Rivals
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University F-75005, Paris, France.
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Patrick Goudot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
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Herrero Babiloni A, De Beaumont L, Lavigne GJ. Transcranial Magnetic Stimulation. Sleep Med Clin 2018; 13:571-582. [DOI: 10.1016/j.jsmc.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Chronic Intermittent Hypoxia Induces the Long-Term Facilitation of Genioglossus Corticomotor Activity. Can Respir J 2018; 2018:5941429. [PMID: 29849832 PMCID: PMC5937571 DOI: 10.1155/2018/5941429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/21/2018] [Accepted: 03/12/2018] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by the repetitive collapse of the upper airway and chronic intermittent hypoxia (CIH) during sleep. It has been reported that CIH can increase the EMG activity of genioglossus in rats, which may be related to the neuromuscular compensation of OSA patients. This study aimed to explore whether CIH could induce the long-term facilitation (LTF) of genioglossus corticomotor activity. 16 rats were divided into the air group (n=8) and the CIH group (n=8). The CIH group was exposed to hypoxia for 4 weeks; the air group was subjected to air under identical experimental conditions in parallel. Transcranial magnetic stimulation (TMS) was applied every ten minutes and lasted for 1 h/day on the 1st, 3rd, 7th, 14th, 21st, and 28th days of air/CIH exposure. Genioglossus EMG was also recorded at the same time. Compared with the air group, the CIH group showed decreased TMS latency from 10 to 60 minutes on the 7th, 14th, 21st, and 28th days. The increased TMS amplitude lasting for 60 minutes was only observed on the 21st day. Genioglossus EMG activity increased only on the 28th day of CIH. We concluded that CIH could induce LTF of genioglossus corticomotor activity in rats.
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Zou Y, Wang W, Jin H, Nie X, Xu J, Liu Y, Kang J. The influence of 5-HT 1A receptors in the dorsal raphé nucleus on genioglossus activity. Respir Physiol Neurobiol 2017; 249:11-15. [PMID: 29208535 DOI: 10.1016/j.resp.2017.11.009] [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: 08/11/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/29/2022]
Abstract
Genioglossus activity maintains the patency of the upper airway. 5-HT neurons in the raphe nucleus regulate genioglossus activity. In order to study the influence of 5-HT1A receptors in dorsal raphé nucleus (DRN) on genioglossus EMG during normoxia, adult male Wistar rats were randomly divided into four groups: the artificial cerebrospinal fluid group (ACSF group), the low-concentration of 5-HT1A receptors agonist 8-OH-DPAT group (0.1 mM group), the mid-concentration 8-OH-DPAT group (0.4 mM group) and the high-concentration 8-OH-DPAT group (1.0 mM group). Rats received 0.1 μl ACSF/8-OH-DPAT microinjections into the DRN. EMG activity of the genioglossus was recorded at 5 min, 15 min and 30 min after microinjection. In three 8-OH-DPAT groups, genioglossus EMG activity significantly decreased at 5 min after microinjection and persisted for 30 min. The significantly decreased EMG activity was more pronounced in the mid- and high-concentration groups than in the low-concentration group, indicating that 5-HT1A receptors in the DRN could rapidly and continuously inhibit genioglossus EMG activity during normoxia.
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Affiliation(s)
- Ying Zou
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang City, China
| | - Wei Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang City, China.
| | - Hongyu Jin
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang City, China
| | - Xinshi Nie
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang City, China
| | - Jiahuan Xu
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang City, China
| | - Ying Liu
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang City, China
| | - Jian Kang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang City, China
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15
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Nie X, Zhou L, Wang A, Jin H, Qin Z, Pang J, Wang W, Kang J. Noradrenergic Activation of Hypoglossal Nucleus Modulates the Central Regulation of Genioglossus in Chronic Intermittent Hypoxic Rats. Front Neurol 2017; 8:171. [PMID: 28507531 PMCID: PMC5410562 DOI: 10.3389/fneur.2017.00171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/12/2017] [Indexed: 11/13/2022] Open
Abstract
Neuromuscular compensation of the genioglossus muscle can be induced by chronic intermittent hypoxia (CIH) in obstructive sleep apnea to maintain upper airway stability. Noradrenergic activation of hypoglossal nucleus plays a critical role in the central control of the genioglossus. However, it remains unknown whether norepinephrine takes part in the central regulation of the genioglossus during CIH. Adult male Wistar rats (n = 32) were studied to explore the influence of noradrenergic activation of hypoglossal nucleus on the central control of the genioglossus at different stages of CIH. The rats were divided into four groups: normal control or normoxic (NO) group, CIH group, CIH + normal saline (NS) group, and CIH + prazosin (PZ, α1-adrenergic antagonist) group. PZ (0.2 mM, 60 nl) and NS (0.9%, 60 nl) were microinjected into the hypoglossal nucleus. The responses of the genioglossus corticomotor area to transcranial magnetic stimulation (TMS) were recorded on the 1st, 7th, 14th, and 21st day of CIH. The CIH group showed significantly shorter TMS latencies on days 1, 7, and 14 (3.85 ± 0.37 vs. 4.58 ± 0.42, 3.93 ± 0.17 vs. 4.49 ± 0.55, 3.79 ± 0.38 vs. 4.39 ± 0.30 ms, P < 0.05), and higher TMS amplitudes on day 1 (2.74 ± 0.87 vs. 1.60 ± 0.52 mV, P < 0.05) of CIH than the NO group. Compared to the CIH + NS group, the CIH + PZ group showed decreased TMS responses (longer latencies and lower amplitudes) only on the 14th day of CIH (3.99 ± 0.28 vs. 4.61 ± 0.48 ms, 2.51 ± 0.67 vs. 1.18 ± 0.62 mV, P < 0.05). These results indicated that noradrenergic activation of the hypoglossal nucleus played a role in the central compensation of genioglossus through α1-adrenoceptor on the 14th day of CIH.
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Affiliation(s)
- Xinshi Nie
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Ling Zhou
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Aidi Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Hongyu Jin
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Zheng Qin
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Jian Pang
- The 463rd Hospital of the Chinese PLA, Shenyang, China
| | - Wei Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
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Launois C, Attali V, Georges M, Raux M, Morawiec E, Rivals I, Arnulf I, Similowski T. Cortical Drive to Breathe during Wakefulness in Patients with Obstructive Sleep Apnea Syndrome. Sleep 2015; 38:1743-9. [PMID: 26158887 DOI: 10.5665/sleep.5156] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/22/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The obstructive sleep apnea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered, imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Experimental inspiratory loading in normal subjects elicits respiratory-related cortical activity. The objective of this study was to test whether awake OSAS patients would exhibit a similar cortical activity. DESIGN Descriptive physiology study. SETTING Sleep laboratory in a large university affiliated tertiary hospital. PATIENTS 26 patients with moderate OSAS according to polysomnography (5 < apnea-hypopnea index [AHI] ≤ 30, n = 14) or severe OSAS (AHI > 30, n = 12); 13 non-OSAS patients for comparison. INTERVENTIONS None. MEASUREMENTS Respiratory time-locked electroencephalographic segments ensemble averaged and analyzed for slow premotor potentials preceding inspiration ("pre-inspiratory potentials" [PIPs]). RESULTS PIPs were present in 1/13 controls and 11/26 patients (P = 0.0336; 4/14 "moderate" and 7/12 "severe" patients). Awake OSAS patients therefore exhibit respiratory-related cortical activity during quiet breathing significantly more frequently than non-OSAS individuals. The corresponding PIPs resemble those observed during prepared voluntary inspirations and in response to experimental inspiratory loads in normal subjects, which involve a cortical network comprising the supplementary motor area. CONCLUSIONS A respiratory-related cortical activity could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in obstructive sleep apnea, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. Whether or not such cortical compensatory mechanisms have cognitive consequences remains to be determined.
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Affiliation(s)
- Claire Launois
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Valérie Attali
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Marjolaine Georges
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Mathieu Raux
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Surveillance Post-Interventionnelle et d'Accueil des Polytraumatisés (Département d'Anesthésie Réanimation), Paris, France
| | - Elise Morawiec
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | - Isabelle Rivals
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,Ecole Supérieure de Physique et de Chimie de la Ville de Paris, Paris, France
| | - Isabelle Arnulf
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
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Borel JC, Melo-Silva CA, Gakwaya S, Rousseau E, Series F. Diaphragm and genioglossus corticomotor excitability in patients with obstructive sleep apnea and control subjects. J Sleep Res 2015; 25:23-30. [DOI: 10.1111/jsr.12337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/02/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Jean-Christian Borel
- Unité de recherche en pneumologie; Centre de recherche; Institut universitaire de cardiologie et de pneumologie de Québec; Université Laval; Quebec QC Canada
| | - Cesar A. Melo-Silva
- Unité de recherche en pneumologie; Centre de recherche; Institut universitaire de cardiologie et de pneumologie de Québec; Université Laval; Quebec QC Canada
| | - Simon Gakwaya
- Unité de recherche en pneumologie; Centre de recherche; Institut universitaire de cardiologie et de pneumologie de Québec; Université Laval; Quebec QC Canada
| | - Eric Rousseau
- Unité de recherche en pneumologie; Centre de recherche; Institut universitaire de cardiologie et de pneumologie de Québec; Université Laval; Quebec QC Canada
| | - Frederic Series
- Unité de recherche en pneumologie; Centre de recherche; Institut universitaire de cardiologie et de pneumologie de Québec; Université Laval; Quebec QC Canada
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Lanza G, Cantone M, Lanuzza B, Pennisi M, Bella R, Pennisi G, Ferri R. Distinctive patterns of cortical excitability to transcranial magnetic stimulation in obstructive sleep apnea syndrome, restless legs syndrome, insomnia, and sleep deprivation. Sleep Med Rev 2015; 19:39-50. [PMID: 24849846 DOI: 10.1016/j.smrv.2014.04.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 01/25/2014] [Accepted: 04/03/2014] [Indexed: 02/07/2023]
Abstract
Altered responses to transcranial magnetic stimulation (TMS) in obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), insomnia, and sleep-deprived healthy subjects have been reported. We have reviewed the relevant literature in order to identify eventual distinctive electrocortical profiles based on single and paired-pulse TMS, sensorimotor modulation, plasticity-related and repetitive TMS measures. Although obtained from heterogeneous studies, the detected changes might be the result of the different pathophysiological substrates underlying OSAS, RLS, insomnia and sleep deprivation rather than reflect the general effect of non-specific sleep loss and instability. OSAS tends to exhibit an increased motor cortex inhibition, which is reduced in RLS; intracortical excitability seems to be in favor of an "activating" profile in chronic insomnia and in sleep-deprived healthy individuals. Abnormal plasticity-related TMS phenomena have been demonstrated in OSAS and RLS. This review provides a perspective of TMS techniques by further understanding the role of neurotransmission pathways and plastic remodeling of neuronal networks involved in common sleep disorders. TMS might be considered a valuable tool in the assessment of sleep disorders, the evaluation of the effect of therapy and the design of non-pharmacological approaches.
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Affiliation(s)
- Giuseppe Lanza
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero, 73, 94018 Troina, EN, Italy.
| | - Mariagiovanna Cantone
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero, 73, 94018 Troina, EN, Italy
| | - Bartolo Lanuzza
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero, 73, 94018 Troina, EN, Italy
| | - Manuela Pennisi
- Department of Chemistry, University of Catania, Viale Andrea Doria, 6, 95125 Catania, Italy
| | - Rita Bella
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy
| | - Giovanni Pennisi
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero, 73, 94018 Troina, EN, Italy
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19
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Abad VC, Guilleminault C. Pharmacological treatment of sleep disorders and its relationship with neuroplasticity. Curr Top Behav Neurosci 2015; 25:503-53. [PMID: 25585962 DOI: 10.1007/7854_2014_365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sleep and wakefulness are regulated by complex brain circuits located in the brain stem, thalamus, subthalamus, hypothalamus, basal forebrain, and cerebral cortex. Wakefulness and NREM and REM sleep are modulated by the interactions between neurotransmitters that promote arousal and neurotransmitters that promote sleep. Various lines of evidence suggest that sleep disorders may negatively affect neuronal plasticity and cognitive function. Pharmacological treatments may alleviate these effects but may also have adverse side effects by themselves. This chapter discusses the relationship between sleep disorders, pharmacological treatments, and brain plasticity, including the treatment of insomnia, hypersomnias such as narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.
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Affiliation(s)
- Vivien C Abad
- Psychiatry and Behavioral Science-Division of Sleep Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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20
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Raphe serotonergic neurons modulate genioglossus corticomotor activity in intermittent hypoxic rats. Respir Res 2014; 15:76. [PMID: 25001907 PMCID: PMC4100526 DOI: 10.1186/1465-9921-15-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022] Open
Abstract
Background Genioglossus activity is greater during wakefulness but decreases to a weaker state during sleep in obstructive sleep apnea syndrome (OSAS) patients, compared to healthy subjects. Previous studies suggested that the corticomotor control of the genioglossus was modified in OSAS patients. Intermittent hypoxia (IH), the typical pathophysiological change in OSAS, can induce genioglossus facilitation. The serotonergic neurons of the raphe dorsal (DRN) and magnus nuclei (RMg) are responsive to hypoxia and play important roles in the control of the genioglossus. However, it remains unknown whether DRN and RMg serotonergic neurons are responsible for the facilitated corticomotor activity of the genioglossus during IH. This study explored the influence of IH on the corticomotor activity of the genioglossus by transcranial magnetic stimulation (TMS), and the role of DRN and RMg serotonergic neurons in this effect. Methods Rats were exposed to IH and divided into two groups. In one group, anti-SERT-SAP was microinjected into the DRN and RMg respectively to kill serotonergic neurons. In the other group, artificial cerebrospinal fluid (ACSF) was injected. Comparisons were conducted between the two groups during four weeks of IH and four weeks after IH. Results Compared to the corresponding ACSF-injected group, the DRN lesion group and RMg lesion group showed longer TMS latencies and lower amplitudes during IH from the 1st to the 28th day. After 28 days of IH, longer latencies and lower amplitudes were seen only in the DRN lesion group. Conclusion These results indicate that DRN and RMg serotonergic neurons play different roles in the facilitation of genioglossus corticomotor activity induced by IH.
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Nardone R, Höller Y, Brigo F, Tezzon F, Golaszewski S, Trinka E. Transcranial magnetic stimulation and sleep disorders: pathophysiologic insights. Sleep Med 2013; 14:1047-58. [PMID: 24051115 DOI: 10.1016/j.sleep.2013.04.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/28/2013] [Accepted: 04/30/2013] [Indexed: 01/15/2023]
Abstract
The neural mechanisms underlying the development of the most common intrinsic sleep disorders are not completely known. Therefore, there is a great need for noninvasive tools which can be used to better understand the pathophysiology of these diseases. Transcranial magnetic stimulation (TMS) offers a method to noninvasively investigate the functional integrity of the motor cortex and its corticospinal projections in neurologic and psychiatric diseases. To date, TMS studies have revealed cortical and corticospinal dysfunction in several sleep disorders, with cortical hyperexcitability being a characteristic feature in some disorders (i.e., the restless legs syndrome) and cortical hypoexcitability being a well-established finding in others (i.e., obstructive sleep apnea syndrome narcolepsy). Several research groups also have applied TMS to evaluate the effects of pharmacologic agents, such as dopaminergic agent or wake-promoting substances. Our review will focus on the mechanisms underlying the generation of abnormal TMS measures in the different types of sleep disorders, the contribution of TMS in enhancing the understanding of their pathophysiology, and the potential diagnostic utility of TMS techniques. We also briefly discussed the possible future implications for improving therapeutic approaches.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
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Saboisky JP, Butler JE, Gandevia SC, Eckert DJ. Functional role of neural injury in obstructive sleep apnea. Front Neurol 2012; 3:95. [PMID: 22715333 PMCID: PMC3375463 DOI: 10.3389/fneur.2012.00095] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 05/28/2012] [Indexed: 12/31/2022] Open
Abstract
The causes of obstructive sleep apnea (OSA) are multifactorial. Neural injury affecting the upper airway muscles due to repetitive exposure to intermittent hypoxia and/or mechanical strain resulting from snoring and recurrent upper airway closure have been proposed to contribute to OSA disease progression. Multiple studies have demonstrated altered sensory and motor function in patients with OSA using a variety of neurophysiological and histological approaches. However, the extent to which the alterations contribute to impairments in upper airway muscle function, and thus OSA disease progression, remains uncertain. This brief review, primarily focused on data in humans, summarizes: (1) the evidence for upper airway sensorimotor injury in OSA and (2) current understanding of how these changes affect upper airway function and their potential to change OSA progression. Some unresolved questions including possible treatment targets are noted.
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23
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Melo-Silva CA, Borel JC, Gakwaya S, Sériès F. Assessment of upper airway dynamics by anterior magnetic phrenic stimulation in conscious sleep apnea patients. J Appl Physiol (1985) 2012; 112:1345-52. [DOI: 10.1152/japplphysiol.01542.2011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Phrenic nerve magnetic stimulation (PNMS) performed anterolaterally at the base of the neck (BAMPS) and cervical magnetic stimulation are common techniques for assessing upper airway (UA) mechanical properties in conscious humans. We considered that if NMS performed at the sternal level (a-MS) could induce a similar percentage of flow-limited twitches as BAMPS in conscious subjects, gauging UA dynamic properties by PNMS would be simplified. Instantaneous flow, pharyngeal and esophageal pressures, as well as thoraco-abdominal motion were recorded in 10 conscious sleep apnea patients. BAMPS and a-MS were applied at end expiration. The percentage of flow-limited twitches, maximal tolerated intensity, and minimal stimulator output associated with flow-limited twitches were similar between BAMPS and a-MS. Examining the effects of stimulation site, stimulation intensity and site*intensity interaction on the characteristics of flow-limited twitches, the former was responsible for more negative peak esophageal pressure (BAMPS: −11.5 ± 0.9 cmH2O; a-MS: −6.5 ± 1.1 cmH2O; P = 0.002) and UA closing pressure (BAMPS: −7.7 ± 0.5 cmH2O; a-MS: −5.8 ± 0.6 cmH2O; P = 0.02) as well as for lower mean linear upper airway resistance (UAR) (BAMPS 3.5 ± 0.4 cmH2O·l−1·s−1; a-MS 2.2 ± 0.4 cmH2O·l−1·s−1; P = 0.02). a-MS systematically evoked outward/inward thoracic displacement, although this movement pattern was observed in only 50% of patients when they were subjected to BAMPS. Linear UAR of BAMPS-induced flow-limited twitches was lower in the presence of initial outward thoracic movement (2 ± 0.05 cmH2O·l−1·s−1) than with inward motion (4.3 ± 1.5 cmH2O·l−1·s−1; P = 0.03). We conclude that a-MS represents a practical and functional technique to evaluate UA mechanical properties in conscious sleep apnea patients.
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Affiliation(s)
- César Augusto Melo-Silva
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Canada; and
- Laboratory of Respiratory Physiology, University of Brasília-UnB, Brasília, Brazil
| | - Jean-Christian Borel
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Canada; and
| | - Simon Gakwaya
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Canada; and
| | - Frédéric Sériès
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Canada; and
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Borel JC, Melo-Silva CA, Gakwaya S, Sériès F. Influence of CO2 on upper airway muscles and chest wall/diaphragm corticomotor responses assessed by transcranial magnetic stimulation in awake healthy subjects. J Appl Physiol (1985) 2012; 112:798-805. [DOI: 10.1152/japplphysiol.00713.2011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rationale: functional interaction between upper airway (UA) dilator muscles and the diaphragm is crucial in the maintenance of UA patency. This interaction could be altered by increasing respiratory drive. The aim of our study was to compare the effects of hypercapnic stimulation on diaphragm and genioglossus corticomotor responses to transcranial magnetic stimulation (TMS). Methods: 10 self-reported healthy men (32 ± 9 yr; body mass index = 24 ± 3 kg/m−2) breathed, in random order, room air or 5% and then 7% FiCO2, both balanced with pure O2. Assessments included ventilatory variables, isoflow UA resistance (at 300 ml/s), measurement of lower chest wall/diaphragm (LCW/diaphragm), and genioglossus motor threshold (MT) and motor-evoked potential (MEP) characteristics. TMS twitches were applied during early inspiration and end expiration at stimulation intensity 30% above LCW/diaphragm and genioglossus MT. Results: compared with room air, CO2 inhalation significantly augmented minute ventilation, maximal inspiratory flow, tidal volume, and tidal volume/respiratory time ratio. UA resistance was unchanged with CO2 inhalation. During 7% CO2 breathing, LCW/diaphragm MT decreased by 9.6 ± 10.1% whereas genioglossus MT increased by 7.2 ± 9%. CO2-induced ventilatory stimulation led to elevation of LCW/diaphragm MEP amplitudes during inspiration but not during expiration. LCW/diaphragm MEP latencies remained unaltered both during inspiration and expiration. Genioglossus MEP latencies and amplitudes were unchanged with CO2. Conclusion: in awake, healthy subjects, CO2-induced hyperventilation is associated with heightened LCW/diaphragm corticomotor activation without modulating genioglossus MEP responses. This imbalance may promote UA instability during increased respiratory drive.
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Affiliation(s)
- Jean-Christian Borel
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Cesar Augusto Melo-Silva
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Simon Gakwaya
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Frédéric Sériès
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
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Hill K, Eastwood P. Effects of loading on upper airway and respiratory pump muscle motoneurons. Respir Physiol Neurobiol 2011; 179:64-70. [DOI: 10.1016/j.resp.2011.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/01/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
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WANG W, KANG J, KONG D. The central motor conductivity of genioglossus in obstructive sleep apnoea. Respirology 2010; 15:1209-14. [DOI: 10.1111/j.1440-1843.2010.01858.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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