Henderson Luke A, Woo Mary A, Macey Paul M, Macey Katherine E, Frysinger Robert C, Alger Jeffry R, Yan-Go Frisca, Harper Ronald M
Department of Neurobiology, School of Nursing, University of California, Los Angeles, Los Angeles, California 90095-1763, USA.
J Appl Physiol (1985). 2003 Mar;94(3):1063-74. doi: 10.1152/japplphysiol.00702.2002. Epub 2002 Nov 1.
The repetitive upper airway muscle atonic episodes and cardiovascular sequelae of obstructive sleep apnea (OSA) suggest dysfunction of specific neural sites that integrate afferent airway signals with autonomic and somatic outflow. We determined neural responses to the Valsalva maneuver by using functional magnetic resonance imaging. Images were collected during a baseline and three Valsalva maneuvers in 8 drug-free OSA patients and 15 controls. Multiple cortical, midbrain, pontine, and medullary regions in both groups showed intensity changes correlated to airway pressure. In OSA subjects, the left inferior parietal cortex, superior temporal gyrus, posterior insular cortex, cerebellar cortex, fastigial nucleus, and hippocampus showed attenuated signal changes compared with controls. Enhanced responses emerged in the left lateral precentral gyrus, left anterior cingulate, and superior frontal cortex of OSA patients. The anterior cingulate, cerebellar cortex, and posterior insula exhibited altered response timing patterns between control and OSA subjects. The response patterns in OSA subjects suggest deficits in particular neural pathways that normally mediate the Valsalva maneuver and compensatory actions in other structures.
阻塞性睡眠呼吸暂停（OSA）的重复性上气道肌肉张力缺失发作和心血管后遗症表明，特定神经部位存在功能障碍，这些神经部位将传入气道信号与自主神经和躯体传出信号整合在一起。我们通过功能磁共振成像确定了对瓦尔萨尔瓦动作的神经反应。在8名未服用药物的OSA患者和15名对照者的基线期以及三次瓦尔萨尔瓦动作期间采集了图像。两组中的多个皮质、中脑、脑桥和延髓区域均显示出与气道压力相关的强度变化。与对照组相比，OSA受试者的左侧顶下皮质、颞上回、岛叶后皮质、小脑皮质、顶核和海马体显示出信号变化减弱。OSA患者的左侧中央前回、左侧前扣带回和额上皮质出现增强反应。对照者和OSA受试者之间，前扣带回、小脑皮质和岛叶后皮质表现出不同的反应时间模式。OSA受试者的反应模式表明，在正常介导瓦尔萨尔瓦动作和其他结构中的代偿性动作的特定神经通路中存在缺陷。
