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Dynamic interaction between the tongue and soft palate during obstructive apnea in anesthetized patients with sleep-disordered breathing

Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan

Submitted 23 April 2003 ; accepted in final form 24 July 2003

Little is known about the mechanisms of persistence of obstructive apnea. Structurally, the dorsum of the tongue locates anterior to the soft palate. On the basis of the observation of posterior displacement of the tongue during obstructive apnea, we hypothesized that the dorsum of the tongue pushes the anterior wall of the soft palate posteriorly during inspiratory efforts, maintaining closure at the retropalatal airway. To test this hypothesis, we measured the pressure between dorsum of the tongue and anterior wall of the soft palate (P_T&P) during experimentally induced obstructive apneas in anesthetized patients with sleep-disordered breathing. P_T&P changes during the obstruction significantly depended on collapsibility of the retroglossal airway. Progressive increase in the P_T&P during obstructive apnea was observed only in patients with highly collapsible retroglossal airways. Significant increase in the P_T&P during inspiratory effort in accordance with positive deflection pattern of P_T&P tracing was evident in the patients with highly collapsible retroglossal airways. The results indicate significant dynamic interaction between the tongue and soft palate during both obstructive apnea and each inspiratory effort, possibly maintaining closure at the retropalatal airway.

airway; pharynx; obstruction; collapsibility; closing pressure

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