Journal of Applied Physiology, Vol 69, Issue 2 443-450, Copyright © 1990 by American Physiological Society

ARTICLES

Fluctuation in timing of upper airway and chest wall inspiratory muscle activity in obstructive sleep apnea

D. W. Hudgel and T. Harasick
Department of Medicine, Case Western Reserve University, Cleveland, Ohio.

An imbalance in the amplitude of electrical activity of the upper airway and chest wall inspiratory muscles is associated with both collapse and reopening of the upper airway in obstructive sleep apnea (OSA). The purpose of this study was to examine whether timing of the phasic activity of these inspiratory muscles also was associated with changes in upper airway caliber in OSA. We hypothesized that activation of upper airway muscle phasic electrical activity before activation of the chest wall pump muscles would help preserve upper airway patency. In contrast, we anticipated that the reversal of this pattern with delayed activation of upper airway inspiratory muscles would be associated with upper airway narrowing or collapse. Therefore the timing and amplitude of midline transmandibular and costal margin moving time average (MTA) electromyogram (EMG) signals were analyzed from 58 apnea cycles in stage 2 sleep in six OSA patients. In 86% of the postapnea breaths analyzed the upper airway MTA peak activity preceded the chest wall peak activity. In 86% of the obstructed respiratory efforts the upper airway MTA peak activity followed the chest wall peak activity. The onset of phasic electrical activity followed this same pattern. During inspiratory efforts when phasic inspiratory EMG amplitude did not change from preapnea to apnea, the timing changes noted above occurred. Even within breaths the relative timing of the upper airway and chest wall electrical activities was closely associated with changes in the pressure-flow relationship. We conclude that the relative timing of inspiratory activity of the upper airway and chest wall inspiratory muscles fluctuates during sleep in OSA.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				F. Series, W. Wang, C. Melot, and T. Similowski Concomitant responses of upper airway stabilizing muscles to transcranial magnetic stimulation in normal men Exp Physiol, April 1, 2008; 93(4): 496 - 502. [Abstract] [Full Text] [PDF]

				J. P. Saboisky, J. E. Butler, D. K. McKenzie, R. B. Gorman, J. A. Trinder, D. P. White, and S. C. Gandevia Neural drive to human genioglossus in obstructive sleep apnoea J. Physiol., November 15, 2007; 585(1): 135 - 146. [Abstract] [Full Text] [PDF]

				W. Wang, T. Similowski, and F. Series Respiratory: Interaction between genioglossus and diaphragm responses to transcranial magnetic stimulation in awake humans Exp Physiol, July 1, 2007; 92(4): 739 - 747. [Abstract] [Full Text] [PDF]

				K.-Z. Lee, D. D. Fuller, I-J. Lu, J.-T. Lin, and J.-C. Hwang Neural drive to tongue protrudor and retractor muscles following pulmonary C-fiber activation J Appl Physiol, January 1, 2007; 102(1): 434 - 444. [Abstract] [Full Text] [PDF]

				D. P. White The Pathogenesis of Obstructive Sleep Apnea: Advances in the Past 100 Years Am. J. Respir. Cell Mol. Biol., January 1, 2006; 34(1): 1 - 6. [Full Text] [PDF]

				P. Bottini, M.L. Dottorini, M. Cristina Cordoni, G. Casucci, and C. Tantucci Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy Eur. Respir. J., October 1, 2003; 22(4): 654 - 660. [Abstract] [Full Text] [PDF]

				F. Series and G. Ethier Assessment of upper airway stabilizing forces with the use of phrenic nerve stimulation in conscious humans J Appl Physiol, June 1, 2003; 94(6): 2289 - 2295. [Abstract] [Full Text] [PDF]

				E. Verin, T. Similowski, A. Teixeira, and F. Series Discriminative power of phrenic twitch-induced dynamic response for diagnosis of sleep apnea during wakefulness J Appl Physiol, January 1, 2003; 94(1): 31 - 37. [Abstract] [Full Text] [PDF]

				E Verin, C Tardif, F Portier, T Similowski, P Pasquis, and J F Muir Evidence for expiratory flow limitation of extrathoracic origin in patients with obstructive sleep apnoea Thorax, May 1, 2002; 57(5): 423 - 428. [Abstract] [Full Text] [PDF]

				F. Series and G. Ethier Site of phrenic nerve stimulation-induced upper airway collapse: influence of expiratory time J Appl Physiol, February 1, 2002; 92(2): 665 - 671. [Abstract] [Full Text] [PDF]

				E. Verin, F. Series, C. Locher, C. Straus, M. Zelter, J.-P. Derenne, and T. Similowski Effects of neck flexion and mouth opening on inspiratory flow dynamics in awake humans J Appl Physiol, January 1, 2002; 92(1): 84 - 92. [Abstract] [Full Text] [PDF]

				F. Series and I. Marc Functional Genomics of Sleep and Circadian Rhythm: Selected Contribution: Influence of genioglossus tonic activity on upper airway dynamics assessed by phrenic nerve stimulation J Appl Physiol, January 1, 2002; 92(1): 418 - 423. [Abstract] [Full Text] [PDF]

				F. SÉRIÈS, C. STRAUS, A. DEMOULE, V. ATTALI, I. ARNULF, J.-P. DERENNE, and T. SIMILOWSKI Assessment of Upper Airway Dynamics in Awake Patients with Sleep Apnea Using Phrenic Nerve Stimulation Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): 795 - 800. [Abstract] [Full Text]

				G. Dhonneur, X. Combes, B. Leroux, and P. Duvaldestin Postoperative Obstructive Apnea Anesth. Analg., September 1, 1999; 89(3): 762 - 762. [Abstract] [Full Text] [PDF]

				F. SÉRIÈS, A. DEMOULE, I. MARC, C. SANFAÇON, J. P. DERENNE, and T. SIMILOWSKI Inspiratory Flow Dynamics During Phrenic Nerve Stimulation in Awake Normals During Nasal Breathing Am. J. Respir. Crit. Care Med., August 1, 1999; 160(2): 614 - 620. [Abstract] [Full Text]

				D. W. HUDGEL, E. A. GORDON, S. THANAKITCHARU, and E. N. BRUCE Instability of Ventilatory Control in Patients with Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., October 1, 1998; 158(4): 1142 - 1149. [Abstract] [Full Text] [PDF]

				G. B. Miles, M. A. Parkis, J. Lipski, and G. D. Funk Modulation of phrenic motoneuron excitability by ATP: consequences for respiratory-related output in vitro J Appl Physiol, May 1, 2002; 92(5): 1899 - 1910. [Abstract] [Full Text] [PDF]