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Vol. 84, Issue 3, 1076-1082, March 1998
Clinica di Semeiotica Medica, University of Ancona, 60020 Ancona, Italy; Laboratoire de Physiopathologie Respiratoire du Service de Pneumologie et Service d'Exploration Fonctionnelle Respiratoire, Groupe Hospitalier Pitié-Salpêtrière, University of Paris VI, Paris, Cedex 13, France; and Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada H2Z 2P2
The application of negative expiratory pressure
(NEP) at end expiration has been shown to cause reflex-mediated
activation of the genioglossus muscle in awake humans. To test whether
a reflex contraction of pharyngeal dilator muscles also occurs in response to NEP applied in early expiration, the effect on genioglossus muscle reflex activity of NEP pulses of 500 ms, given 0.2 s after the
onset of expiration and during the end-expiratory pause, was assessed
in 10 normal awake subjects at rest. The raw and integrated surface
electromyogram of the genioglossus (EMGgg) was recorded with airflow
and mouth pressure under control conditions and with NEP ranging from
3 to 10 cmH2O.
Intraoral EMGgg was also recorded under the same experimental
conditions in two subjects. The application of NEP at the
end-expiratory pause elicited a consistent reflex response of EMGgg in
seven subjects with a mean latency of 68 ± 5 ms. In contrast, when
NEP was applied at the onset of expiration, EMGgg reflex activity was
invariably observed in only one subject. No relationship was found
between steady increase or abrupt fall in expiratory flow and the
presence or the absence of a reflex activity of genioglossus during
sudden application of NEP at the beginning of expiration. Our results
show that a reflex activity of genioglossus is elicited much more
commonly during application of NEP at the end rather than at the onset
of expiration. These findings also suggest that when NEP is applied in
early expiration to detect intrathoracic flow limitation the absence of
upper airways narrowing does not imply the occurrence of a
reflex-mediated activation of genioglossus and vice versa.
negative pressure; expiration; upper airway collapsibility
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