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Medical Service, John D. Dingell Veterans Affairs Medical Center, and the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan 48201
It has been proposed that the upper airway
compliance should be highest during rapid eye movement (REM) sleep.
Evidence suggests that the increased compliance is secondary to an
increased retroglossal compliance. To test this hypothesis, we examined
the effect of sleep stage on the relationship of retroglossal
cross-sectional area (CSA; visualized with a fiber-optic scope) to
pharyngeal pressure measured at the level of the oropharynx during
eupneic breathing in subjects without significant sleep-disordered
breathing. Breaths during REM sleep were divided into phasic
(associated with eye movement, PREM) and tonic (not associated with eye
movements, TREM). Retroglossal CSA decreased with non-REM (NREM) sleep
and decreased further in PREM [wake 156.8 ± 48.6 mm2, NREM 104.6 ± 65.0 mm2
(P < 0.05 wake vs. NREM), TREM 83.1 ± 46.4 mm2 (P = not significant NREM vs. TREM),
PREM 73.9 + 39.2 mm2 (P < 0.05 TREM
vs. PREM)]. Retroglossal compliance, defined as the slope of the
regression CSA vs. pharyngeal pressure, was the same between all four
conditions (wake 
0.7 + 2.1 mm2/cmH2O,
NREM 0.6 ± 3.0 mm2/cmH2O, TREM 0.2 ± 3.3 mm2/cmH2O, PREM 0.6 ± 5.1 mm2/cmH2O, P = not
significant). We conclude that the intrinsic properties of the airway
wall determine retroglossal compliance independent of changes in the
neuromuscular activity associated with changes in sleep state.
upper airway; imaging; nasopharynx; rapid eye movement sleep
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