Dr. Avram Gold, a clinical physiologist, is pioneering a new understanding of the pathophysiology of obstructive sleep apnea (OSA). This research interest began in the mid-1990’s with his recognition that the clinical consequences of OSA are independent of sleep fragmentation by arousals associated with apnea and hypopnea, and independent of changes in oxyhemoglobin saturation. Even the mildest, inaudible fluttering of the upper airway during sleep (termed inspiratory airflow limitation), a finding that would go unrecognized in most people experiencing it, is enough to result in the sleepiness, fatigue and insomnia that characterize OSA patients. While coming to this new understanding of upper airway behavior during sleep, Dr. Gold noticed a high prevalence of symptoms like migraine/tension headaches, irritable bowels, arthralgia/myalgia and temporomandibular joint syndrome in the OSA patients coming to his sleep medicine clinic. These symptoms are commonly associated with the somatic syndromes; disabling syndromes for which there are no adequate treatments and which have been traditionally associated with chronic stress.To determine whether unrecognized inspiratory airflow limitation plays a role in the somatic syndromes, Dr. Gold studied inspiratory airflow dynamics during sleep in a case series of females with fibromyalgia and compared the inspiratory airflow dynamics during sleep of females with irritable bowel syndrome and veterans with Gulf War illness to those of matched controls. He found that indeed, unrecognized inspiratory airflow limitation is present in somatic syndrome patients, and that prevention of the inspiratory airflow limitation with nasal CPAP decreases the severity of symptoms among somatic syndrome patients.To continue elucidating the relationship between inspiratory airflow limitation during sleep and the somatic syndromes, Dr. Gold collaborated with Dr. Joan Broderick of the Department of Psychiatry to develop a questionnaire, the body sensation questionnaire (BSQ) to quantify stress in his patients with OSA and somatic syndromes. By having all of his sleep medicine patients complete a BSQ along with questionnaires evaluating sleepiness, fatigue and insomnia, in a large clinical series, Dr. Gold has demonstrated that chronic stress is the principal pathophysiology underlying OSA as well as the somatic syndromes and that treatments that prevent inspiratory airflow limitation during sleep decrease chronic stress. Dr. Gold’s work suggests that inspiratory airflow limitation during sleep may be a large, unrecognized cause of chronic stress and its many associated illnesses.Dr. Gold continues his clinically-based research examining the relationship between measured stress levels and metabolic syndrome with its cardiovascular outcomes in his OSA patients. He has also begun to work collaboratively with maxillo-facial surgery to offer maxillomandibular advancement as curative treatment for patients with a variety of somatic syndromes and affective disorders who demonstrate mild inspiratory airflow limitation during sleep, collecting case series of this pioneering approach to treatment.
Selected papers:
- Gold AR, Dipalo F, Gold MS, O’Hearn D. The symptoms and signs of upper airway resistance syndrome: a link to the functional somatic syndromes. Chest 123:87-95, 2003.
- Gold AR, Dipalo F, Gold MS, Broderick JE. Inspiratory airflow dynamics during sleep in female fibromyalgia patients. Sleep 27:459-66, 2004.
- Gold AR, Broderick JE, Amin MM, Gold MS. Inspiratory airflow dynamics during sleep in irritable bowel syndrome: a pilot study. Sleep Breath 13:397-407, 2009.
- Amin MM, Belisova Z, Hossain S, Gold MS, Broderick JE, Gold AR. Inspiratory airflow dynamics during sleep in veterans with Gulf War illness: a controlled study. Sleep Breath 15(3):, 333-9, 2011.
- Amin MM, Gold MS, Broderick JE, Gold AR. The effect of nasal continuous positive airway pressure on the symptoms of Gulf War illness. Sleep Breath 15(3): 579-87, 2011.
- Gold AR. Functional somatic syndromes, anxiety disorders and the upper airway: a matter of paradigms. Sleep Med Rev 15: 389-401, 2011.
- Miller P, Iyer M, Gold AR. Treatment resistant adolescent depression with upper airway resistance syndrome treated with rapid palatal expansion: a case report. Journal of Medical Case Reports 6:415, 2012.
- Broderick JE, Gold MS, Amin MM, Gold AR. Self-report somatic arousal correlates with sleep complaints among females with irritable bowel syndrome: a pilot study. J Sleep Disor: Treat Care 1:2, 20, 2012.
- Gold AR, Broderick JE, Gold MS, Amin MM. A comparison of inspiratory airflow dynamics during sleep between upper airway resistance syndrome patients and healthy controls. Sleep Breath 17(4):1169-78 20, 2013.
- Broderick JE, Gold MS, Amin MM, Gold AR. The association of somatic arousal with the symptoms of upper airway resistance syndrome. Sleep Medicine 15(4):436-43 2014.
- Gold MS, Amdo T, Hasaneen N, Gold AR. Somatic arousal and sleepiness / fatigue among patients with sleep disordered breathing. Sleep Breath 20(2): 749-58 2016.
- Amdo T, Hasaneen N, Gold MS, Gold AR. Somatic syndromes, insomnia, anxiety and somatic arousal among sleep disordered breathing patients. Sleep Breath 20(2): 759-68 2016.
- Proothi M, Grazina VJR, Gold AR. Chronic insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series. J Med Case Rep 2019 Aug 14;13(1):252. doi:10.1186/s13256-019-2182-9.
