Waking and genioglossus muscle responses to upper airway pressure oscillation in sleeping dogs

1990 ◽  
Vol 68 (6) ◽  
pp. 2564-2573 ◽  
Author(s):  
L. Plowman ◽  
D. C. Lauff ◽  
M. Berthon-Jones ◽  
C. E. Sullivan
Keyword(s):  
Rem Sleep ◽  
Slow Wave Sleep ◽  
Upper Airway ◽  
Pressure Oscillation ◽  
Pressure Waves ◽  
Sleep State ◽  
Upper Airways ◽  
Airway Patency ◽  
Obstructive Sleep ◽  
Oscillatory Pressure

We studied waking and genioglossus electromyographic (EMGgg) responses to oscillating pressure waves applied to the upper airways of three sleeping dogs. The dogs were previously prepared with a permanent side-hole tracheal stoma and were trained to sleep with a tight-fitting snout mask, hermetically sealed in place, while breathing through a cuffed endotracheal tube inserted through the tracheostomy. Sleep state was determined by behavioral, electroencephalographic, and electromyographic criteria, and EMGgg activity was measured using fine bipolar electrodes inserted directly into the muscle. Oscillatory pressure waves of 30 Hz and +/- 3 cmH2O (tested at atmospheric and subatmospheric upper airway pressures) were applied at the dog's nostrils or larynx, either constantly for a period of 1 min or in 0.5-s bursts. We found that the pressure stimulus had two major effects. First, it was a potentially powerful arousal-promoting stimulus. Arousal occurred in 78% of tests in slow-wave sleep (SWS) and 55% of tests in rapid-eye-movement (REM) sleep, with swallowing and sighing accompanying many of the arousals. Second, it produced an immediate and sustained augmentation of EMGgg, in wakefulness, SWS, and REM sleep. We conclude that oscillatory pressure waves in the upper airway, as found in snoring, produce reflex responses that help maintain upper airway patency during sleep. Loss of this type of reflex might contribute to the onset of obstructive sleep apnea in chronic snorers.

Association between Flexible Nasal Endoscopy, Polysonography Findins and Obstructive Sleep Apnea Severety

2021 ◽  
Vol 9 (3) ◽  
pp. 01-06
Author(s):  
Zappelini CEM ◽  
Jeremias LA ◽  
Borba IN ◽  
Machado LZ ◽  
Nicoladelli SJ ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rem Sleep ◽  
Sleep Stage ◽  
Upper Airway ◽  
Inverse Correlation ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Cross Sectional ◽  
Obstructive Sleep

Introduction: Obstructive Sleep Apnea (OSA) is a condition with recurrent collapses of the pharyngeal region that result in partial or total reduction in airflow. Its diagnosis and severity depends on the Apnea-Hypopnea Index (AHI), data from the polysomnography exam (PSG). Its pathophysiology includes anatomical disorders of the upper airways that can be assessed through Flexible Nasofibroscopy (FN). Objective: To identify the alterations present in the tests of FN and PSG in patients with OSA and correlate with the AHI. Methods: Cross-sectional study, with data collected from reports of the FN and PSG exams of 81 patients with OSA, seen at an otorhinolaryngology clinic in Tubarão - SC. It was verified the association between the outcome –AHI- and other exposure variables - sociodemographic and clinical. Results: Among the 81 patients, 75.31% were male, 41.98% had mild apnea, 30.86% moderate and 27.16% severe apnea. There was no correlation between FN findings and AHI (p> 0.05). There was a difference between the mean age, number of obstructive episodes per hour of sleep and minimum saturation between the groups with severe and mild apnea (p <0.05). Patients with severe apnea had a higher percentage of sleep phase one and a shorter REM sleep time compared to the mild apnea group (p <0.05). A positive correlation was obtained between: obstructive episodes with sleep stage 1 (p <0.01) and age (p <0.05); between minimum saturation and sleep stage 3 (p <0.05). There was an inverse correlation between obstructive episodes with minimal saturation (p <0.001), with sleep stage 3 (p <0.01) and with REM sleep (p <0.01); between age and minimum saturation (p <0.01). Conclusion: OSA directly interferes with sleep architecture. The present study did not find association between upper airway alterations and OSA severity.

scholarly journals GABA and glycine neurons from the ventral medullary region inhibit hypoglossal motoneurons

SLEEP ◽  
2019 ◽  
Vol 43 (6) ◽  
Author(s):  
Olga Dergacheva ◽  
Thomaz Fleury-Curado ◽  
Vsevolod Y Polotsky ◽  
Matthew Kay ◽  
Vivek Jain ◽  
...  
Keyword(s):  
Rem Sleep ◽  
Muscle Tone ◽  
Upper Airway ◽  
Emg Activity ◽  
Airway Patency ◽  
Hypoglossal Motoneurons ◽  
Obstructive Sleep ◽  
Tongue Muscles

Abstract Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive sleep-related losses of upper airway patency that occur most frequently during rapid eye movement (REM) sleep. Hypoglossal motoneurons play a key role in regulating upper airway muscle tone and patency during sleep. REM sleep activates GABA and glycine neurons in the ventral medulla (VM) to induce cortical desynchronization and skeletal muscle atonia during REM sleep; however, the role of this brain region in modulating hypoglossal motor activity is unknown. We combined optogenetic and chemogenetic approaches with in-vitro and in-vivo electrophysiology, respectfully, in GAD2-Cre mice of both sexes to test the hypothesis that VM GABA/glycine neurons control the activity of hypoglossal motoneurons and tongue muscles. Here, we show that there is a pathway originating from GABA/glycine neurons in the VM that monosynaptically inhibits brainstem hypoglossal motoneurons innervating both tongue protruder genioglossus (GMNs) and retractor (RMNs) muscles. Optogenetic activation of ChR2-expressing fibers induced a greater postsynaptic inhibition in RMNs than in GMNs. In-vivo chemogenetic activation of VM GABA/glycine neurons produced an inhibitory effect on tongue electromyographic (EMG) activity, decreasing both the amplitude and duration of inspiratory-related EMG bursts without any change in respiratory rate. These results indicate that activation of GABA/glycine neurons from the VM inhibits tongue muscles via a direct pathway to both GMNs and RMNs. This inhibition may play a role in REM sleep associated upper airway obstructions that occur in patients with OSA.

scholarly journals Permeabilization surgery of the upper respiratory tract and its effects on sleep fragmentation and REM sleep

2017 ◽  
Vol 7 (25) ◽  
pp. 47-56 ◽  
Author(s):  
Ionut Tanase ◽  
Claudiu Manea ◽  
Codrut Sarafoleanu
Keyword(s):  
Sleep Disorders ◽  
Surgical Procedures ◽  
Rem Sleep ◽  
Slow Wave Sleep ◽  
Upper Airway ◽  
Sleep Fragmentation ◽  
Upper Respiratory Tract ◽  
Upper Airways ◽  
Falling Asleep ◽  
Before And After

AbstractUsually, patients with sleep disorders may complain of tiredness, fatigue, daytime sleepiness, difficulty in concentrating, and can reach up to falling asleep in inappropriate situations – condition known as the Pickwick syndrome. To avoid these unpleasant symptoms, a series of surgical procedures regarding the anatomical structures involved in sleep apnea were developed.The article is a general review regarding the sleep disorders and the influence of upper airways permeability on the quality of sleep and the sleep staging distribution. Also, we present some preliminary data obtained in a clinical study underwent in CESITO Centre “Sfanta Maria” Hospital, Bucharest, involving patients with sleep pathology that had polysomnographic evaluations before and after various surgical procedures of nasal and pharyngeal permeabilization.AIMS.To determine that permeabilization surgery of the upper airway tract may be used successfully in order to decrease the sleep fragmentation and increase the time of slow-wave sleep.CONCLUSION.6 months after the permeabilization surgery of the upper airway tract, the polysomnography reveals that the arousals index decreased and the sleep architecture undergoes changes that consist in decreasing the Stage 1 and Stage 2 sleep, therefore REM sleep reaches a better score.

Genioglossus and breathing responses to airway occlusion: effect of sleep and route of occlusion

1988 ◽  
Vol 64 (2) ◽  
pp. 543-549 ◽  
Author(s):  
F. G. Issa ◽  
P. Edwards ◽  
E. Szeto ◽  
D. Lauff ◽  
C. Sullivan
Keyword(s):  
Rem Sleep ◽  
Slow Wave Sleep ◽  
Upper Airway ◽  
Linear Increase ◽  
Inspiratory Time ◽  
Sleep State ◽  
Airway Occlusion ◽  
Pressure Changes ◽  
Occlusion Effect

We examined the effect of sleep state on the response of genioglossus muscle (EMGgg) activity to total airway occlusion applied at 1) nasal (N) airway [and thus exposing the upper airway (UAW) to pressure changes] and 2) tracheal (T) airway (thus excluding UAW from pressure changes). A total of 233 tests were performed during wakefulness (W), 98 tests in slow-wave sleep (SWS), and 72 tests in rapid-eye-movement (REM) sleep. Prolongation of inspiratory time (TI) of the first occluded effort occurred in all tests irrespective of behavioral state, with the greatest increase seen in awake N tests. Nasal tests augmented EMGgg activity in the first occluded breath and produced a linear increase in EMGgg during occlusion. The EMGgg activity at any given time during nasal occlusion in SWS was less than that recorded during W tests. There was a marked reduction in EMGgg response to N occlusion during REM sleep. The EMGgg activity during awake T tests was significantly less than that of N tests at any given time during occlusion. There was no relationship between the level of EMGgg activity and asphyxia in T tests performed during SWS and REM sleep. Nasal tests decreased the force generated by the inspiratory pump muscles and the central drive to breathing compared with T tests. These results confirm the important role of the UAW in regulating breathing pattern and indicate that both immediate and progressive load-compensating responses during nasal occlusion are influenced by information arising from the UAW.

scholarly journals Upper Airway Collapsibility During REM Sleep in Children with the Obstructive Sleep Apnea Syndrome

SLEEP ◽  
2009 ◽  
Vol 32 (9) ◽  
pp. 1173-1181 ◽  
Author(s):  
Jingtao Huang ◽  
Laurie R. Karamessinis ◽  
Michelle E. Pepe ◽  
Stephen M. Glinka ◽  
John M. Samuel ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Rem Sleep ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Apnea Syndrome ◽  
Upper Airway Collapsibility

Inspiratory coactivation of the genioglossus enlarges retroglossal space in laryngectomized humans

1996 ◽  
Vol 80 (5) ◽  
pp. 1595-1604 ◽  
Author(s):  
I. Kobayashi ◽  
A. Perry ◽  
J. Rhymer ◽  
B. Wuyam ◽  
P. Hughes ◽  
...  
Keyword(s):  
Upper Airway ◽  
Dependent Manner ◽  
Tongue Movement ◽  
Forward Movement ◽  
Upper Airways ◽  
Posterior Aspect ◽  
Airway Patency ◽  
Significant Movement ◽  
Tongue Position ◽  
Tracheal Stoma

To investigate the relationship between the electrical activity of the genioglossus (GG-EMG) and associated tongue movement, seven laryngectomized subjects breathing through a tracheal stoma (without pressure or flow change in the upper airway) were studied in the supine position. Tongue movement, with the use of lateral fluoroscopy, and GG-EMG expressed as a percentage of maximum voluntary genioglossal activation were monitored simultaneously during 1) spontaneous inspiration (SI), 2) resistive loaded inspiration (LI), and 3) rapid inspiration (RI). Tongue position during each maneuver was compared with its position during spontaneous expiration. Peak GG-EMG during the three maneuvers was significantly different from each other (SI: 5.4 +/- 1.6, LI: 11.9 +/- 1.8, and RI: 51.6 +/- 9.4 (SE) %, respectively). Associated forward movement of the posterior aspect of the tongue was minimum during SI; however, significant movement was observed during LI, and this was increased during RI. Significant covariance existed between peak GG-EMG and this movement. Genioglossal coactivation with inspiration enlarges the glossopharyngeal airway, particularly in its caudal part. In subjects with intact upper airways, this activation may protect or enhance upper airway patency in an effort-dependent manner.

scholarly journals Compensatory responses to upper airway obstruction in obese apneic men and women

2012 ◽  
Vol 112 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Chien-Hung Chin ◽  
Jason P. Kirkness ◽  
Susheel P. Patil ◽  
Brian M. McGinley ◽  
Philip L. Smith ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Rem Sleep ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Upper Airway Obstruction ◽  
Men And Women ◽  
Compensatory Responses ◽  
Obstructive Sleep

Defective structural and neural upper airway properties both play a pivotal role in the pathogenesis of obstructive sleep apnea. A more favorable structural upper airway property [pharyngeal critical pressure under hypotonic conditions (passive Pcrit)] has been documented for women. However, the role of sex-related modulation in compensatory responses to upper airway obstruction (UAO), independent of the passive Pcrit, remains unclear. Obese apneic men and women underwent a standard polysomnography and physiological sleep studies to determine sleep apnea severity, passive Pcrit, and compensatory airflow and respiratory timing responses to prolonged periods of UAO. Sixty-two apneic men and women, pairwise matched by passive Pcrit, exhibited similar sleep apnea disease severity during rapid eye movement (REM) sleep, but women had markedly less severe disease during non-REM (NREM) sleep. By further matching men and women by body mass index and age ( n = 24), we found that the lower NREM disease susceptibility in women was associated with an approximately twofold increase in peak inspiratory airflow ( P = 0.003) and inspiratory duty cycle ( P = 0.017) in response to prolonged periods of UAO and an ∼20% lower minute ventilation during baseline unobstructed breathing (ventilatory demand) ( P = 0.027). Thus, during UAO, women compared with men had greater upper airway and respiratory timing responses and a lower ventilatory demand that may account for sex differences in sleep-disordered breathing severity during NREM sleep, independent of upper airway structural properties and sleep apnea severity during REM sleep.

Mass loading of the upper airway extraluminal tissue space in rabbits: effects on tissue pressure and pharyngeal airway lumen geometry

2009 ◽  
Vol 106 (3) ◽  
pp. 887-892 ◽  
Author(s):  
Kristina Kairaitis ◽  
Lauren Howitt ◽  
John R. Wheatley ◽  
Terence C. Amis
Keyword(s):  
Pressure Transducer ◽  
Tissue Expander ◽  
Upper Airway ◽  
Fat Pad ◽  
Pharyngeal Wall ◽  
Airway Patency ◽  
Pharyngeal Airway ◽  
Obstructive Sleep ◽  
Tracheal Pressure ◽  
Tissue Space

Lateral pharyngeal fat pad compression of the upper airway (UA) wall is thought to influence UA size in patients with obstructive sleep apnea. We examined interactions between acute mass/volume loading of the UA extra-luminal tissue space and UA patency. We studied 12 supine, anesthetized, spontaneously breathing, head position-controlled (50°), New Zealand White rabbits. Submucosal extraluminal tissue pressures (ETP) in the anterolateral (ETPlat) and anterior (ETPant) pharyngeal wall were monitored with surgically inserted pressure transducer-tipped catheters (Millar). Tracheal pressure (Ptr) and airflow (V̇) were measured via a pneumotachograph and pressure transducer inserted in series into the intact trachea, with hypopharyngeal cross-sectional area (CSA) measured via computed tomography, while graded saline inflation (0–1.5ml) of a compliant tissue expander balloon in the anterolateral subcutaneous tissue was performed. Inspiratory UA resistance (Rua) at 20 ml/s was calculated from a power function fitted to Ptr vs. V̇ data. Graded expansion of the anterolateral balloon increased ETPlat from 2.3 ± 0.5 cmH2O ( n = 11, mean ± SEM) to 5.0 ± 1.1 cmH2O at 1.5-ml inflation ( P < 0.05; ANOVA). However, ETPant was unchanged from 0.5 ± 0.5 cmH2O ( n = 9; P = 0.17). Concurrently, Rua increased to 119 ± 4.2% of baseline value ( n = 12; P < 0.001) associated with a significant reduction in CSA between 10 and 70% of airway length to a minimum of 82.2 ± 4.4% of baseline CSA at 40% of airway length ( P < 0.05). We conclude that anterolateral loading of the upper airway extraluminal tissue space decreases upper airway patency via an increase in ETPlat, but not ETPant. Lateral pharyngeal fat pad size may influence UA patency via increased tissue volume and pressure causing UA wall compression.

Ventilatory responses to CO2 and lung inflation in tonic versus phasic REM sleep

1979 ◽  
Vol 47 (6) ◽  
pp. 1304-1310 ◽  
Author(s):  
C. E. Sullivan ◽  
E. Murphy ◽  
L. F. Kozar ◽  
E. A. Phillipson
Keyword(s):  
Eye Movements ◽  
Rem Sleep ◽  
Slow Wave Sleep ◽  
Minute Volume ◽  
Sleep State ◽  
Lung Inflation ◽  
Ventilatory Responses ◽  
Sustained Inflation ◽  
Per Se ◽  
Phasic Rem Sleep

Ventilatory responses to CO2 and to lung inflation were compared in four dogs during tonic and phasic segments of rapid-eye-movement (REM) sleep. Phasic REM sleep (P-REM) was identified by the presence of bursts of rapid eye movements, visible muscle twitchings, and frequent phasic discharges in the nuchal electromyogram. These features were absent during tonic REM sleep (T-REM). During P-REM the response of minute volume of ventilation (VI) to progressive hypercapnia (0.58 +/- 0.19 (l/min)/Torr, mean +/- SE) was significantly less than in slow-wave sleep (SWS) (1.40 +/- 0.14; P less than 0.05). In contrast, during T-REM the response (1.48 +/- 0.19) was similar to that in SWS. Similarly, during P-REM the duration of apnea (5.9 +/- 1.5 s) elicited by sustained inflation of the lungs with 1.0 liter of air, was significantly shorter than in SWS (25.8 +/- 0.8); in contrast, during T-REM the duration of apnea (17.8 +/- 3.6) was similar to that in SWS. The results indicate that previously described decreases in VI responses to CO2 and apneic responses to lung inflation during P-REM, compared to SWS, are related to the phasic phenomena of REM sleep, rather than to the REM sleep state per se.

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