The Future of Sleep Apnea Therapy Atul Malhotra, MD ([email protected]) Associate Professor of Medicine Medical Director, Sleep Program Clinical Chief, Sleep Division BWH and SHC Harvard Medical School NESS 2010. Inadequate Anatomy Compensatory Reflex Activity of
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Hypoxia + Hypercapnia
Malhotra and White
Patients do not all get OSA for the same reason.
There are likely to be multiple mechanistic pathways and we need to recognize and target them.
Owens et al. SLEEP 2009; Saboisky Thorax 2010
Pharyngeal anatomy explains only a minimal portion of the variability in AHI
A 1-cm mandibular advancement has a substantial impact on collapsibility:P close = -21 cmH2O with; -13 cmH2O without mandibular advancement
Huang, White and Malhotra, Chest 2005
Jordan et al Thorax 2007, Sleep 2009
Saboisky et al. Thorax 2010
Park et al SLEEP 2008
Chamberlin et al.
Younes AJRCCM 2001
Wellman et al JAP 2003
Wellman et al AJRCCM 2004
Wellman et al J Physiol 2007
Wellman et al. Resp Physiol 2008 Jordan et al J Physiol 2004
Jordan et al JAP 2006
p = 0.076
p = 0.0016
Effort Index = (E2 – E1) / E2
R = 0.96
P < 0.05
High Loop Gain
Administer agents to reduce loop gain:
p = 0.016
Resp Physiol 2008
Grants PI: Malhotra