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Donald F. Klein, MD
New York State Psychiatric Institute 722 W 168th St New York, NY 10032

Arch Gen Psychiatry. 1997;54(7):678.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Ley¹ still inexplicably and evasively ignores my point that patients with the Ondine curse do not feel distressed while actually suffocating. He simply confuses the matter by gratuitously suggesting that an alarm system has to be either off or maximally on. Clearly many physiological alarm systems produce mounting discomfort and activation but do not lead to a full-fledged maximum reaction unless adaptive action has failed to be effective. Ley obscures the issue by a physiologically unwarranted dictum about how alarm systems work.

Central sleep apnea is a pathological feature of the breathing control mechanism; patients with central sleep apnea breathe insufficiently except during full wakefulness. Such patients are quite similar to patients with the Ondine curse, so this does not contradict my views. In obstructive sleep apnea, obesity or upper airway narrowing may result in hypoxia and hypercapnia, which may induce central apnea. During sleep apnea, the usual response . . . [Full Text PDF of this Article]

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