David M. Rapoport, MD

Adjunct Professor, Department of Medicine

Keywords
sleep disordered breathing , sleep apnea, control of breathing, control of the upper airway
Summary

The recently described clinical syndrome of obstructive sleep apnea (OSAS), possibly affecting 2% to 10% of the adult population, is characterized by episodic sleep-induced changes in upper airway patency. These produce respiratory compromise ranging from partial to complete occlusion. Because obstruction represents a major challenge to homeostatic respiratory control mechanisms and because it can be completely reversed with a simple nasal mask/airway pressure device known as a nasal CPAP, OSAS provides an extraordinary opportunity to study control of breathing in humans.

Upper airway obstruction in OSAS results from interaction between subtle anatomic airway narrowing, increased wall collapsibility due sleep-induced loss of baseline muscle tone, and insufficient inspiratory phasic dilator muscle contraction to oppose the negative intraluminal pressure resulting from diaphragmatic contraction. This collapsible behavior can be modelled with a Starling resistor; exploring the properties of this model should provide insights into pathophysiology and treatment. One key observation is that a sinusoidally varying driving force (inspiratory diaphragmatic drive) acting through such a collapsible tube results in an inspiratory waveform which "flow limits." Although defined by pressure/flow relationships, flow limitation can be recognized by a flat contour of the inspiratory waveform in the flow/time display.

Appreciation of the information content of this easily obtained and noninvasive measurement has provided three research directions in our laboratory: 1) defining the role of the upper airway in sleep-related changes in respiratory control in normal subjects and patients with cardiorespiratory failure resulting in apnea and chronic hypercapnia; 2) developing diagnostic techniques to screen patients for the occurrence of sleep-related respiratory abnormalities; and 3) developing a technique for closed-loop computer-controlled regulation of the treatment for OSAS, e.g., a variation on nasal CPAP which automatically seeks the optimal pressure on a continuous basis.

These focus areas and their associated publications are derived from medical subject headings from PubMed.
represents one publication
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Adjunct Professor, Department of Medicine

MD from Albert Einstein College of Medicine

Kishi, Akifumi; Van Dongen, Hans P A; Natelson, Benjamin H; Bender, Amy M; Palombini, Luciana O; Bittencourt, Lia; Tufik, Sergio; Ayappa, Indu; Rapoport, David M

PLoS one. 2017 Apr 10; 12(4):e0175504-e0175504e0175504

Hilz, Max J; Moeller, Sebastian; Buechner, Susanne; Czarkowska, Hanna; Ayappa, Indu; Axelrod, Felicia B; Rapoport, David M

Journal of clinical sleep medicine : JCSM. 2016 Dec 15; 12(12):1607-1614

Williams, Natasha J; Robbins, Rebecca; Rapoport, David; Allegrante, John P; Cohall, Alwyn; Ogedgebe, Gbenga; Jean-Louis, Girardin

Trials. 2016 Dec 08; 17(1):585-585

Varga, Andrew W; Wohlleber, Margaret E; Gimenez, Sandra; Romero, Sergio; Alonso, Joan F; Ducca, Emma L; Kam, Korey; Lewis, Clifton; Tanzi, Emily B; Tweardy, Samuel; Kishi, Akifumi; Parekh, Ankit; Fischer, Esther; Gumb, Tyler; Alcolea, Daniel; Fortea, Juan; Lleo, Alberto; Blennow, Kaj; Zetterberg, Henrik; Mosconi, Lisa; Glodzik, Lidia; Pirraglia, Elizabeth; Burschtin, Omar E; de Leon, Mony J; Rapoport, David M; Lu, Shou-En; Ayappa, Indu; Osorio, Ricardo S

Sleep. 2016 Nov 01; 39(11):2041-2048

Zandieh, Stephanie O; Cespedes, Amarilis; Ciarleglio, Adam; Bourgeois, Wallace; Rapoport, David M; Bruzzese, Jean-Marie

Journal of asthma. 2016 Oct 14; 54(1):62-68

Mitchell, John; Berger, Kenneth I; Borgo, Andrea; Braunlin, Elizabeth A; Burton, Barbara K; Ghotme, Kemel A; Kircher, Susanne G; Molter, David; Orchard, Paul J; Palmer, James; Pastores, Gregory M; Rapoport, David M; Wang, Raymond Y; White, Klane

European journal of internal medicine. 2016 Oct; 34:2-10

Osorio, Ricardo S; Ducca, Emma L; Wohlleber, Margaret E; Tanzi, Emily B; Gumb, Tyler; Twumasi, Akosua; Tweardy, Samuel; Lewis, Clifton; Fischer, Esther; Koushyk, Viachaslau; Cuartero-Toledo, Maria; Sheikh, Mohammed O; Pirraglia, Elizabeth; Zetterberg, Henrik; Blennow, Kaj; Lu, Shou-En; Mosconi, Lisa; Glodzik, Lidia; Schuetz, Sonja; Varga, Andrew W; Ayappa, Indu; Rapoport, David M; de Leon, Mony J

Sleep. 2016 Jun 01; 39(6):1253-1260

Varga, Andrew W; Ducca, Emma L; Kishi, Akifumi; Fischer, Esther; Parekh, Ankit; Koushyk, Viachaslau; Yau, Po Lai; Gumb, Tyler; Leibert, David P; Wohlleber, Margaret E; Burschtin, Omar E; Convit, Antonio; Rapoport, David M; Osorio, Ricardo S; Ayappa, Indu

Neurobiology of aging. 2016 Jun; 42:142-149