Title : The role of compromised cerebrospinal fluid circulation in sleep apnea
Abstract:
Since its first literary description by Charles Dickens in 1833, followed by its first scientific description in 1949, interest in sleep disturbances has skyrocketed (over 40,000 documented scientific papers have discussed the problem). Sleep apnea, however, remains an incompletely understood affliction. A complicated interconnected causal construct has been fashioned with different treatment modalities proposed and monitored. We suggest that an unappreciated factor may be episodic CSF disturbances often caused by cervical stenosis. On this point much evidence exists that, in an older population, osseous overgrowth may restrict the CSF pathways through which CSF normally flows from the cerebrum into the spinal canal. Such obstruction would logically result in episodic pressure disjunction.
Such pressure disturbances via the fourth ventricle would directly impact the pons and medulla, structures in which the complicated anatomical and neurophysiological arrangements responsible for respiratory regulation reside. CSF pressure alterations generally make their appearance in an aging population at exactly the time that neuronal population and fibrous tract integrity in the brainstem may have been selectively compromised, and, importantly, on the same timeline in which the symptoms of sleep apnea often appear.
Logically, such CSF circulation disturbances, coupled with the naturally occurring aging process, would diminish robust brainstem function, causing a primary increase in sympathetic neuronal stimulation. Such an event then serves to provoke a vicious cycle, causing a number of physiological shortfalls.
Understanding the vagaries of CSF circulation (which in some ways might be likened to the physiological impact of blood pressure variation) and instituting appropriate therapeutic interventions might effectuate neurological improvement, interrupting the vicious cycle through which sleep apnea interferes with normal physiological balance. The treatment of cervical stenosis as a causal vector in sleep apnea could be conservatively effectuated by posture changes or, in more aggressive circumstances, surgical intervention.
