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1 Department of Veterans Affairs Sleep Disorders Center-Northport, Division of Pulmonary/Critical Care Medicine, Department of Medicine, State University of New York-Stony Brook, Stony Brook, New York 11794; and 2 The Johns Hopkins Sleep Disorders Center, Hopkins Bayview Campus, Baltimore, Maryland 21224
The upper airway is a complicated
structure that is usually widely patent during inspiration. However, on
inspiration during certain physiological and pathophysiological states,
the nares, pharynx, and larynx may collapse. Collapse at these
locations occurs when the transmural pressure (Ptm) at a flow-limiting
site (FLS) falls below a critical level (Ptm'). On airway
collapse, inspiratory airflow is limited to a maximal level
(
Imax)
determined by (
Ptm')/Rus, where Rus is the resistance
upstream to the FLS. The airflow dynamics of the upper airway are
affected by the activity of its associated muscles. In this study, we
examine the modulation of
Imax
by muscle activity in the nasal airway under conditions of inspiratory
airflow limitation. Each of six subjects performed sniffs through one
patent nostril (pretreated with an alpha agonist) while flaring the
nostril at varying levels of dilator muscle (alae nasi) EMG activity
(EMGan). For each sniff, we located the nasal FLS with an airway
catheter and determined
Imax,
Ptm', and Rus. Activation of the alae nasi from the lowest to the
highest values of EMGan increased
Imax
from 422 ± 156 to 753 ± 291 ml/s (P < 0.01) and decreased
Ptm' from
3.6 ± 3.0 to
6.0 ± 4.7 cmH2O (P < 0.05). Activation of the alae
nasi had no consistent effect on Rus.
Imax
was positively correlated with EMGan, and Ptm' was negatively
correlated with EMGan in all subjects. Our findings demonstrate that
alae nasi activation increases
Imax
through the nasal airway by decreasing airway collapsibility.
Starling resistor; airway collapsibility; upper airway
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