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Vol. 83, Issue 5, 1588-1594, 1997
Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas 77555-0561
Kuna, Samuel T., and Christi R. Vanoye.
Respiratory-related pharyngeal constrictor muscle activity in
decerebrate cats. J. Appl. Physiol.
83(5): 1588-1594, 1997.
Respiratory-related activity of the
hyopharyngeus (middle pharyngeal constrictor) and thyropharyngeus
(inferior pharyngeal constrictor) muscles was determined in
decerebrate, tracheotomized adult cats and compared with the
electromyographic activity of the thyroarytenoid, a vocal cord
adductor. During quiet breathing, the hyopharyngeus and usually the
thyroarytenoid exhibited phasic activity during expiration and tonic
activity throughout the respiratory cycle. Respiratory-related thyropharyngeus activity was absent under these conditions. Progressive hyperoxic hypercapnia and progressive isocapnic hypoxia increased phasic expiratory activity in both pharyngeal constrictor (PC) muscles
but tended to suppress thyroarytenoid activity. Passively induced
hypocapnia and the central apnea that followed the cessation of the
mechanical hyperventilation were associated with tonic activation of
the hyopharyngeus and thyroarytenoid but no recruitment in
thyropharyngeus activity. The expiratory phase of a sigh and progressive pneumothorax were associated with an increase in phasic thyroarytenoid activity but no change in phasic PC activity. The results indicate that a variety of stimuli modulate respiratory-related PC activity, suggesting that the PC muscles may have a role in the
regulation of upper airway patency during respiration.
hyopharyngeus; thyropharyngeus; thryoarytenoid; transversus
abdominis; electromyograms
THE SUPERIOR, MIDDLE, AND INFERIOR pharyngeal
constrictors (PCs) are saillike muscles that help form the lateral and
posterior walls of the pharyngeal airway. They arise from
the dorsal midline pharyngeal aponeurosis and attach to various
anterior structures in the ventral wall of the pharyngeal airway. In
animals, the middle PC is termed the hyopharyngeus (HP) and consists of
the chondropharyngeus and keratopharyngeus muscles. The inferior PC is
termed the thyropharyngeus (TP). The pharyngeal branch of the vagus
nerve supplies motor output to the PC muscles in cats (4, 6, 21, 24).
The PC muscles are activated after the oral phase of swallowing and are
believed to promote pharyngeal airway closure. Respiratory-related PC
activity is of interest because previous investigators have speculated
that PC muscle activation may promote pharyngeal airway closure during
sleep in patients with obstructive sleep apnea (25). Previous
investigators have examined the respiratory-related activity of the PC
muscles in cats. Sherrey and Megirian (24) performed whole nerve
recordings in anesthetized, spontaneously breathing cats and found
expiratory activity in the nerve branches innervating the TP and HP.
More recently, Grélot et al. (6) recorded the discharge of motor
axons supplying the PC muscles in decerebrate, paralyzed, artificially
ventilated cats. Most units fired only in expiration and exhibited a
steady, a decreasing, or a late augmenting discharge pattern.
Inspiratory units with a steady, late augmenting, or tonic discharge
pattern were also present. From electromyogram (EMG) studies in
anesthetized cats, it has been found that
1) the HP and TP exhibit phasic
activity in expiration and tonic activity throughout the respiratory
cycle during quiet breathing, 2)
phasic HP activity increases under hypercapnic conditions (5% inspired
CO2), and
3) passively induced hypocapnia is
associated with the emergence of tonic PC activation (21, 23). Murakami
and Kirchner (21) report that the chondropharyngeus and
keratopharyngeus portions of the HP have the same activation patterns. These previous studies are largely qualitative
and report the response to only one level of hypercapnia.
The purpose of the present study was to extend this previous work by
providing a quantitative analysis of respiratory-related PC activity in
response to a variety of respiratory-related stimuli, including
progressive changes in chemical drive and lung volume. Respiratory-related activity of the TP and HP was determined in decerebrate cats during 1) quiet
breathing, 2) spontaneous sighs, 3) progressive hyperoxic
hypercapnia, 4) progressive
isocapnic hypoxia, 5) passively
induced hyperventilation, and 6)
decreased lung volume. The EMG responses of the PC muscles under these
conditions were compared with those of the thyroarytenoid muscle, a
vocal cord adductor that helps brake expiratory airflow. The results indicate that a variety of stimuli modulate respiratory-related PC
activity, suggesting that the PC muscles help regulate pharyngeal airway patency during respiration.
Acute experiments were performed in 21 adult cats of either sex
weighing 3.0-4.0 kg. The protocol was approved by the Animal Care
Committee of The University of Texas Medical Branch at Galveston. Anesthesia was induced with halothane. The animals were intubated, and
the anesthetic was continued until completion of all surgery. Arterial
blood pressure was monitored with a cannula attached to a pressure
transducer (Statham) in the femoral artery. A cannula in the femoral
vein was used to infuse medications and fluids. Mean blood pressure
remained above 100 mmHg in all animals. Temperature of the animals was
controlled at 37°C with a servo-controlled heating pad (Yellow
Springs Instruments). After administration of 3 mg iv dexamethasone to
help control brain edema, an intercollicular decerebration was
performed by using the technique of Kirsten and St. John (12). A
tracheotomy was performed through a midline ventral neck incision, and
cannulas were placed in the rostral and caudal trachea. The animals
breathed through the caudal tracheotomy tube throughout the recordings.
A pneumotachograph (Fleisch) attached to a differential pressure
transducer (Statham) was connected to the tracheotomy tube. The
resulting flow signal was integrated over time to obtain tidal volume.
Volume was calibrated with a 50-ml syringe. A sidearm in the
tracheotomy tube was used to continuously sample gas for the
measurement of end-tidal CO2
(Datex) and O2 (Amtek). Paired
38-gauge hooked-wire electrodes (Belden) were implanted under direct
vision into the chondropharygeus part of the HP
(n = 21), TP
(n = 5), and transversus abdominis
(n = 10) muscles. The
chondropharyngeus part of the HP was chosen because it is the larger
part of the HP and is easily exposed (21). TP recordings were only
obtained in the last several experiments. There were no technical
problems associated with recording this EMG. Electrodes were also
implanted into the thyroarytenoid muscle (n = 15) through the cricothyroid
membrane. Correct position of the latter electrodes was confirmed on
autopsy. The EMG signals were amplified, filtered (Grass, Tektronics),
and displayed on an oscilloscope. All data were recorded on polygraph
(Gould) and magnetic tape (Neurocorder).
Recordings were obtained under the following conditions: quiet
breathing, spontaneous sighs, progressive hyperoxic hypercapnia, progressive isocapnic hypoxia, passively induced hypocapnia, and progressively induced pneumothorax. At least 10 min
separated each intervention, during which all signals returned to their baseline state. Normally the animals breathed room air supplemented with O2. Progressive hyperoxic
hypercapnia was induced by connecting the tracheotomy tube to a 1-liter
reservoir bag containing 7% CO2-balance
O2. The rebreathe was continued
until the end-tidal CO2 reached
9%. Progressive isocapnic hypoxia was induced by altering the levels
of inspired O2 and
CO2 as the animals breathed
through a T tube attached to the pneumotachograph. Each level of
O2 was maintained for a minimum of
3 min. The minimum level of end-tidal O2 tested was 5%. The effect of
passively induced hypocapnia on EMG activity was determined by
hyperventilating the animals with the mechanical ventilator (Harvard
Apparatus). During the hypocapnic state, abrupt cessation of mechanical
ventilation induced a central apnea, i.e., a cessation of tracheal
airflow for at least 5 s. Only trials resulting in a central
apnea were considered for analysis.
At the end of the experiments, an 8-Fr tube was inserted through the
thoracic wall into the pleural space. A unilateral pneumothorax was
induced by injecting 20-ml aliquots of air into the thoracic cavity
every minute to a maximum volume of 100 ml. TP and transversus abdominis EMGs were not recorded during the pneumothorax trials. Posterior cricoarytenoid (PCA) EMG activity was recorded in three cats.
Hooked wires were implanted into the PCA by gently rotating the larynx
and inserting the electrodes dorsal to the cricoid cartilage. Correct
placement of the PCA electrodes was confirmed on autopsy. Also during
the progressively induced pneumothorax trials, a constant airflow
(37°C, saturated) was passed in the expiratory direction through
the rostral tracheal cannula and subglottic pressure (Statham) was
recorded from a sidearm in the cannula.
, flow; Insp, inspiration; Exp, expiration; MA,
moving average. Horizontal lines under MA signals represent electrical zero.
Progressive hyperoxic hypercapnia and progressive isocapnic hypoxia. Minute ventilation at 9% end-tidal CO2 was 463 ± 166% of control. The effect of progressive hyperoxic hypercapnia on PC activity in individual cats is shown in Figs. 1 and 2. For the group as a whole, progressive hypercapnia was associated with progressive recruitment of phasic expiratory activity of the two PC muscles but no change in tonic activity (Fig. 3). Phasic HP activity at 8.0, 8.5, and 9.0% end-tidal CO2 was significantly increased from that at normocapnia. Phasic HP activity at 9.0% end-tidal CO2 was 264 ± 124% of its normocapnic value. Phasic TP activity appeared soon after the onset of hypercapnia and tended to increase with progressive hypercapnia.
) and tonic
(
) activity of HP (A) and TP
(B) in all cats. Data at each
CO2 level are expressed as
percentage of maximum peak activity (max) of respective muscle during
hypercapnic rebreathe and are plotted as means ± SD.
Phasic TP and HP activity usually had a plateaulike discharge pattern throughout expiration at moderate hypercapnic levels and an augmenting or plateaulike discharge pattern throughout expiration at the highest levels of hypercapnia. Onset of phasic activity often began in late inspiration, and, in some instances, a biphasic discharge pattern was present. Preactivation of the HP was 0.16 ± 0.07 s or 26 ± 13% of inspiratory time during quiet breathing and 0.18 ± 0.04 s or 34 ± 6% of inspiratory time at 9% end-tidal CO2. TP preactivation was 0.14 ± 0.02 s or 25 ± 5% of inspiratory time at 9% end-tidal CO2 and showed no significant difference over the hypercapnic range. Minute ventilation at 5% end-tidal O2 was 390 ± 204% of its hyperoxic value. Compared with progressive hyperoxic hypercapnia, progressive isocapnic hypoxia was associated with a relatively small increase in phasic expiratory HP and TP activation. Phasic HP activity was significantly increased at 5% end-tidal O2 (149 ± 26% of control). There was no change in PC tonic activity during progressive hypoxia. In general, phasic thyroarytenoid activity either decreased or was not recruited under hypercapnic and hypoxic conditions. However, phasic thyroarytenoid activity increased at the highest end-tidal CO2 levels in three cats and increased at the lowest end-tidal O2 levels in three cats. Two of the three cats were common to both conditions. For the group as a whole, the changes in phasic thyroarytenoid activity were not significant. Phasic thyroarytenoid activity was 94 ± 117% of control at 9% end-tidal CO2 and 139 ± 59% of control at 5% end-tidal O2. Phasic expiratory transversus abdominis activity appeared under hypercapnic and hypoxic conditions and increased with increasing chemical drive (Fig. 1). Passively induced hypocapnia. During passive hyperventilation, the end-tidal CO2 was 4.9 ± 0.7% during quiet breathing before the onset of mechanical ventilation and 3.0 ± 0.5% just before cessation of mechanical ventilation. During passive hyperventilation, the HP became tonically active at a level less than or equal to its peak activity during spontaneous breathing just before the onset of passive hyperventilation (Fig. 4). Peak HP activity just before the cessation of passive hyperventilation was 77 ± 24% of peak activity during the control period. Cessation of passive hyperventilation resulted in a central apnea. Tonic activation of the HP never increased during the apnea and in some instances decreased in the latter part of the apnea. Phasic HP activation resumed with the onset of spontaneous respiration. In some cases, phasic activity of the HP continued throughout the hyperventilation and apneic periods, despite the absence of respiratory efforts as evidenced by absence of flow during the apnea. Like the HP, the thyroarytenoid became tonically active during mechanical hyperventilation. In contrast to the HP, thyroarytenoid activity progressively increased during the passive hyperventilation. Peak thyroarytenoid activity just before the cessation of hyperventilation was 564 ± 852% of peak activity during spontaneous breathing. There was no recruitment of TP or transversus abdominis activity during the passive hyperventilation or ensuing central apnea.
Sighs. Sighs were most commonly observed under hypoxic conditions and during the progressive pneumothorax trials. The EMG discharge patterns during sighs appeared to be independent of the underlying condition. Figure 5 shows the PC discharge pattern during a sigh. The inspiratory portion of the sigh was associated with a significant decrease in tonic HP activity (84 ± 22% of control) but no change in thyroarytenoid activity (99 ± 5% of control). The expiratory portion of the sigh was associated with a significant increase in thyroarytenoid activity (779 ± 947% of control) but no change in HP activity (120 ± 16% of control). Transversus abdominis activity during the expiratory portion of the sigh was not significantly different from control (170 ± 54% of control). Sighs were present in only three of the five cats with TP EMG recordings, and the results were inconsistent.
Progressively induced pneumothorax. Progressively induced unilateral pneumothorax was associated with the appearance of a rapid shallow breathing pattern. Minute ventilation at 100-ml pneumothorax volume was 114 ± 26% of control. As shown for one cat in Fig. 6 and for the group in Fig. 7, progressive pneumothorax was not associated with a change in HP activity. Phasic HP activity at 100 ml pneumothorax volume was 91 ± 14% of control. In contrast, progressive pneumothorax was associated with a significant increase in phasic thyroarytenoid activity. At 100-ml pneumothorax volume, phasic thyroarytenoid activity was 858 ± 655% of control. Manual chest wall compression was also associated with an increase in phasic thyroarytenoid activity but no change in PC activity.
) and TA (
)
activity in all cats.
Our results in decerebrate cats are in general agreement with the findings of previous investigators (4, 6, 21, 23, 24). Our results indicate that a variety of respiratory stimuli modulate middle and inferior PC muscle activity. During quiet breathing, the HP (middle PC) routinely exhibited phasic expiratory activity and tonic activation throughout the respiratory cycle. Respiratory-related TP (inferior PC) activity was absent during quiet breathing. Previous investigators have reported an increase in phasic expiratory PC muscle activity with increased chemical drive (21, 23). However, Sherrey and Megirian (23) only tested the HP response to one level of hypercapnia (5% inhaled CO2), and the chemical stimulus used by Murakami and Kirchner (21) is not detailed. The present results show that progressive hyperoxic hypercapnia is associated with progressive recruitment of phasic expiratory activity in both PC muscles. Similar responses were seen during progressive isocapnic hypoxia. In agreement with previous investigators, phasic PC activity when present began in late inspiration. In general, the phasic activation had a plateaulike discharge pattern throughout expiration at normocapnia but a progressively increasing ramplike pattern under hypercapnic conditions.
It is important to note that technical limitations associated with hooked-wire EMG recordings may have influenced the results. For the same muscle activation, distortion of the muscle by its own contraction or that of neighboring muscles can alter the ohmic resistance between the recording electrodes, modifying the EMG signal. This is of particular concern for a region so mechanically complex as the upper airway. Electroneurograms of the nerve supplying motor output to the PC muscles would circumvent this potential problem but were not obtained in this study.
The results reported in this study and in previous studies in cats contrast with those reporting PC activity in other animal species. Basmajian and Dutta (2) detected no respiratory-related PC activity in conscious or anesthetized adult rabbits. In contrast, Kawasaki et al. (10, 11) reported that PC muscles in anesthetized dogs exhibit phasic activity on expiration and, in some cases, on inspiration. Although not presented in the results, phasic PC activation on inspiration was only apparent in our experiments during induced cough.
Comparison of the present results with those of previous studies in normal adult humans reveals both similarities and differences (2, 8, 19, 20, 22). During quiet breathing in normal adult humans, the superior, middle, and inferior PC muscles rarely exhibit respiratory-related activity during wakefulness and are electrically silent during non-rapid-eye-movement (NREM) sleep. When present, phasic activation occurs in expiration. The results of Sauerland et al. (22) that the superior PC in normal adult humans usually exhibits phasic expiratory activity during wakefulness and sleep is not supported by more recent studies (19, 20). The results of Sauerland et al. during wakefulness may be explained by their subjects being instructed to "breathe deeply (even forcefully) to emphasize EMG activity related to respiration." As in decerebrate cats, progressive hypercapnia and progressive hypoxia in adult humans are associated with a recruitment and progressive increase in phasic expiratory PC activity (19, 20). In decerebrate cats, passive hypocapnic hyperventilation is associated with tonic activation of the HP but no TP recruitment. In contrast, passive hypocapnic hyperventilation during NREM sleep in adult humans is not associated with PC muscle activation (19).
The mechanical effect of the PC muscles on pharyngeal airway function is unknown (1). Of particular interest is the increased PC activation during expiration under hypercapnic and hypoxic conditions. Why would constrictor muscles surrounding a potentially collapsible portion of the airway be activated when the organism is attempting to increase minute ventilation? Sherrey and Megirian (24) speculated that PC activation under hypercapnic conditions may help reduce anatomic dead space. Murakami and Kirchner (21) speculated that PC activation functions to "lift" the hyoid bone and thyroid cartilage rostrally after their descent in the preceding inspiration. Grélot et al. (6) speculated that respiratory-related PC activation may stiffen and dilate the pharyngeal airway.
Both the PC muscles and the laryngeal adductor muscles exhibit phasic activation on expiration. This similarity has led to the speculation that the respiratory-related function of the PC muscles is similar to that of the laryngeal adductors, i.e., to brake expiratory airflow, thus helping to control the time of expiration and expiratory lung volume (1). However, hypoxia and hypercapnia increased PC activity but tended to suppress TA activity. Stimuli associated with a decrease in lung volume (progressive pneumothorax, chest wall compression) were associated with an increase in thryoarytenoid activity but no change in PC activity. Sherrey and Megirian (24) reported that deflating the lungs over one respiratory cycle by aspirating 20-30 ml of air from the lungs at end expiration was associated with a virtual elimination of TP activity. However, this statement is not supported by the actual recordings, which show a decrease in tonic activity without a change in phasic expiratory activity (Fig. 1 in Ref. 24). The marked differences between PC and thyroarytenoid responses to respiratory stimuli provide circumstantial evidence suggesting that the PC muscles and vocal cord adductors have different mechanical effects on upper airway function. This difference is not surprising given the very different anatomy of the two respective airway segments. Whereas the larynx is a valvelike structure, the pharyngeal segment is a potentially collapsible tube.
Unlike known pharyngeal dilator muscles such as the genioglossus, which have phasic inspiratory activity, phasic PC activity is predominantly expiratory. Except for this difference, the response of the PC muscles to respiratory-related stimuli is much more similar to that of the pharyngeal dilators than to the laryngeal adductors. A progressive increase in phasic genioglossus activity is consistently observed with progressive hyperoxic hypercapnia or isocapnic hypoxia. The similar recruitment in phasic PC activity with increased chemical drive suggests that the PC muscles may be functioning in a manner similar to or in concert with other pharyngeal dilators to stiffen and enlarge the pharyngeal airway. Supporting this speculation are the observations that the superior PC has an activation pattern similar to that of a pharyngeal dilator during NREM sleep in patients with obstructive sleep apnea (7, 17).
In summary, our EMG findings in decerebrate cats show marked differences in the respiratory-related activation of the PC and thyroarytenoid muscles. Progressive hypercapnia and progressive hypoxia increased phasic PC activity but tended to suppress phasic thyroarytenoid activity. The expiratory phase of a sigh was associated with an increase in phasic thyroarytenoid activity but no change in phasic PC activity. Progressive pneumothorax was associated with an increase in phasic thyroarytenoid activity but no change in PC activity. The results strongly suggest that the PC muscles, unlike the vocal cord adductors, do not brake expiratory airflow. On the basis of our EMG findings in decerebrate cats and humans, we hypothesize that the PC muscles may constrict or dilate the pharyngeal airway dependent on airway size. This functional duality would not be unique to the PC muscles. Though internal intercostal muscles generally promote exhalation, their contraction at very low lung volumes facilitates inspiration (5). Although the evidence is circumstantial, this hypothesis regarding the mechanical effects of PC muscle activation would reconcile the seemingly contradictory activation of these muscles during swallowing and respiration.
This work was funded by the Moody Foundation and National Heart, Lung, and Blood Institute Grant HL-27520.
Address for reprint requests: S. T. Kuna, Pulmonary Div., The Univ. of Texas Medical Branch, 301 Univ. Blvd., Galveston, TX 77555-0561.
Received 20 February 1997; accepted in final form 8 July 1997.
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