ABSTRACT
Sleep is the only naturally occurring behavioral state in which humans experience repeated airway obstructions. Many patients are unaware of these airway obstructions and their major complaint is excessive daytime sleepiness. Elucidating the neurochemical control of sleep is essential, therefore, for a complete understanding of the etiology, characteristics, and treatment of obstructive sleep apnea. The goal of this chapter is to describe how neurochemical studies of rapid eye movement (REM) sleep are providing novel insights into pontine acetylcholine (ACh) as a regulator of sleep and breathing. The chapter is organized around three themes, beginning with an overview of the cholinergic model of REM sleep. The second section shows how enhancing cholinergic neurotransmission in a nonrespiratory region of the pontine reticular formation significantly alters upper airway muscle control, ventilation, chemosensitivity, and neuronal excitability. The third section presents evidence that protein profiling can specify pre-and postsynaptic proteins contributing to the cholinergic modulation of sleep and breathing. A diverse assortment of molecules influence sleep and breathing. The chapter concludes with unifying evidence
that many of the molecules that alter REM sleep do so by modulating pontine cholinergic neurotransmission.
