Obstructive sleep apnea (OSA) - what level of respiratory dysregulation is involved and are respiratory stimulants relevant?

Question

There are some people who when sleeping seem to power through obstructions to their breathing by breathing strongly such that they snore at a very loud volume. For people with obstructive sleep apnea syndrome (OSAS), how much of the fact that they stop breathing is due to their body not just trying to breath harder?

In other words, for some people is OSA actually perhaps a combination of obstructive and central apnea in that while there is some obstruction, if their respiration were to be more stimulated, they would actually have no apnea (i.e. AHI of 0 even though they may have obstruction which could otherwise cause apnea).

Part of what prompted this question is also wondering whether there are any respiratory stimulants which could help overcome this sort of situation, especially in lean individuals with OSA where the obstruction is perhaps not super severe. For example, caffeine citrate is used in preterm infants as a respiratory stimulant to treat apnea of prematurity (AOP), though that is different than OSA.

Answer 1

Although not a "respiratory stimulant" in the sense of stimulating muscles of respiratory, hypoglossal nerve stimulation devices, such as INSPIRE, can stimulate your tongue to move forward when sleeping, which opens up the upper airway and allows for better breathing.

The STAR trial showed that hypoglossal nerve stimulation can reduce sleep apnea events by up to 68% after 12 months of treatment.

Source:

1. Strollo PJ Jr, Soose RJ, Maurer JT, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139-149. doi:10.1056/NEJMoa1308659