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This chapter summarizes functional neuroimaging findings from a variety of autonomic and respiratory challenges the author's group has performed in people with obstructive sleep apnea (OSA). A cold pressor challenge involves exposing a body region to a cold stimulus, which elicits a sympathetic activation that leads to a vasoconstriction and a blood pressure increase. The Valsalva maneuver is an autonomic challenge involving straining by forceful expiration against a closed glottis, and the tasks elicit a sequence of blood pressure and heart rate responses mediated through a coordination of autonomic regulatory activity. The inspiratory and expiratory loading tasks led to a degree of dyspnea in most subjects, as did the Valsalva maneuver to a lesser extent. An abnormal pattern in OSA is altered insular functional neuroanatomy in response to autonomic stimuli, as seen with higher-resolution functional magnetic resonance imaging (fMRI) in response to the Valsalva maneuver.
Sleep disturbances, especially insomnia, may be caused by a broad range of psychiatric disorders, in particular by mood and psychotic disorders, anxiety disorders, dementia, substance related and personality disorders. Depression is the most frequent cause of insomnia. The group of anxiety disorders consists of phobic disorders, panic disorder, generalized anxiety disorder, and combined fear and depression. Women are more than twice as likely as men to develop posttraumatic stress disorder (PTSD) after exposure to a psychological trauma. The lifetime prevalence of schizophrenia has been reported as ranging from 1% to 2%, and about 0.025% to 0.05% of the total population is treated for schizophrenia in any single year. Sedating neuroleptics may be suitable for treatment of sleep disturbances because these substances are well tolerated and may positively influence both insomnia and anxiety/confusion with only minor hangover effects.
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