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Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Québec, Canada G1V 4G5
Electrical phrenic nerve stimulation
(EPNS) applied at end expiration during exclusive nasal breathing can
be used to characterize upper airway (UA) dynamics during wakefulness
by dissociating phasic activation of UA and respiratory muscles. The UA
level responsible for the EPNS-induced increase in UA resistance is unknown. The influence of the twitch expiratory timing (200 ms and
2 s) on UA resistance was studied in nine normal awake subjects by
looking at instantaneous flow, esophageal and pharyngeal pressures, and
genioglossal electromyogram (EMG) activity during EPNS at baseline and
at
10 cmH2O. The majority of twitches had a flow-limited pattern. Twitches realized at 200 ms and 2 s did not differ in their maximum inspiratory flows, but esophageal pressure measured at
maximum inspiratory flow was significantly less negative with late
twitches (
6.6 ± 2.7 and
5.0 ± 3.0 cmH2O
respectively, P = 0.04). Pharyngeal resistance was
higher when twitches were realized at 2 s than at 200 ms (6.4 ± 2.4 and 2.7 ± 1.1 cmH2O · l
1 · s,
respectively). EMG activity significant rose at peak esophageal pressure with a greater increase for late twitches. We conclude that
twitch-induced UA collapse predominantly occurs at the pharyngeal level
and that UA stability assessed by EPNS depends on the expiratory time
at which twitches are performed.
maximum inspiratory flow; electrical phrenic nerve stimulation; flow limitation
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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] |
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