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J Appl Physiol (June 28, 2007). doi:10.1152/japplphysiol.00026.2007
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Submitted on January 7, 2007
Accepted on June 22, 2007

Lung Volume and Collapsibility of the Passive Pharynx in Patients with Sleep-disordered Breathing

Yugo Tagaito1, Shiroh Isono2*, John E. Remmers3, Atsuko Tanaka1, and Takashi Nishino1

1 Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan
2 Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan; Chiba, Japan
3 Department of Medicine, University of Calgary, Faculty of Medicine, Calgary, Canada

* To whom correspondence should be addressed. E-mail: isonos-chiba{at}umin.ac.jp.

Lung volume dependence of pharyngeal airway patency suggests involvement of lung volume in pathogenesis of obstructive sleep apnea. We examined the structural interaction between passive pharyngeal airway and lung volume independent of neuromuscular factors. Static mechanical properties of the passive pharynx were compared before and during lung inflation in eight anesthetized and paralyzed patients with sleep-disordered breathing. The respiratory system volume was increased by applying negative extra-thoracic pressure, thereby leaving the trans-pharyngeal pressure unchanged. Application of -50cmH2O negative extra-thoracic pressure produced an increase in lung volume of 0.72 (0.63-0.91) liter (median (25-75 percentile), resulting in a significant reduction of velopharyngeal closing pressure of 1.22 (0.14-2.03) cmH2O without significantly changing collapsibility of the oropharyngeal airway. Improvement of the velopharyngeal closing pressure was directly associated with body mass index. We conclude that increase in lung volume structurally improves velopharyngeal collapsibility particularly in obese patients with sleep-disordered breathing.




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