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J Appl Physiol 93: 1365-1376, 2002. First published July 5, 2002; doi:10.1152/japplphysiol.00942.2001
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Vol. 93, Issue 4, 1365-1376, October 2002

Modulation of upper airway collapsibility during sleep: influence of respiratory phase and flow regimen

Hartmut Schneider1, An Boudewyns2, Philip L. Smith1, Christopher P. O'Donnell1, Sebastian Canisius3, Axel Stammnitz3, Lawrence Allan1, and Alan R. Schwartz1

3 Sleep Laboratory, Phillips-University of Marburg, 35032 Marburg, Germany; 2 Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Antwerp, B-2650 Edegem, Belgium; and 1 Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224

We hypothesized that upper airway collapsibility is modulated dynamically throughout the respiratory cycle in sleeping humans by alterations in respiratory phase and/or airflow regimen. To test this hypothesis, critical pressures were derived from upper airway pressure-flow relationships in six tracheostomized patients with obstructive sleep apnea. Pressure-flow relationships were generated by varying the pressure at the trachea and nose during tracheostomy (inspiration and expiration) (comparison A) and nasal (inspiration only) breathing (comparison B), respectively. When a constant airflow regimen was maintained throughout the respiratory cycle (tracheostomy breathing), a small yet significant decrease in critical pressure was found at the inspiratory vs. end- and peak-expiratory time point [7.1 ± 1.6 (SE) to 6.6 ± 1.9 to 6.1 ± 1.9 cmH2O, respectively; P < 0.05], indicating that phasic factors exerted only a modest influence on upper airway collapsibility. In contrast, we found that the inspiratory critical pressure fell markedly during nasal vs. tracheostomy breathing [1.1 ± 1.5 (SE) vs. 6.1 ± 1.9 cmH2O; P < 0.01], indicating that upper airway collapsibility is markedly influenced by differences in airflow regimen. Tracheostomy breathing was also associated with a reduction in both phasic and tonic genioglossal muscle activity during sleep. Our findings indicate that both phasic factors and airflow regimen modulate upper airway collapsibility dynamically and suggest that neuromuscular responses to alterations in airflow regimen can markedly lower upper airway collapsibility during inspiration.

obstructive sleep apnea; critical pressure; collapsibility; tracheostomy


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