ABSTRACT

Whether it is hypoxia, hypercapnia, or increased airway resistance, the final pathway for arousal from sleep appears to be the level of ventilatory effort (44). Awakening from sleep, whatever the cause, leads to an increase in ventilation, just as sleep onset is associated with a decrease in ventilation. In patients with sleep apnea, this arousal response to the increase in airway resistance has been termed respiratory effort-related arousal (RERA) and is an important feature of sleep apnea. Patients with this disorder tend to awaken at relatively reproducible levels of pleural pressure and this arousal may occur without the development of either significant hypoxemia or significant hypercapnia.