Abstract
To the Editor: I read with interest the article by Eckert and colleagues regarding phenotypic causes of obstructive sleep apnea (OSA) (1). One of their findings was an elevated respiratory arousal threshold in adults with OSA, and it was noted that direct comparisons of the respiratory arousal threshold between patients with OSA and control subjects have not been previously performed. In fact, studies have shown that children with OSA have higher arousal thresholds to a number of respiratory stimuli (such as hypercapnia [2] and inspiratory resistance loading [3]), but not to nonrespiratory stimuli (4), compared with age-matched control subjects. The arousal threshold changes over the course of normal development, with children having a higher arousal threshold compared with adults (5). However, the study by Eckert and coworkers showing blunted respiratory arousal thresholds in adults with OSA suggests that deficits in arousal are a common pathogenic mechanism for OSA across the age spectrum.
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