Obstructive sleep apnea: Electromyographic and fiberoptic studies

Guilleminault, Christian; Hill, Michael W.; Simmons, F. Blair; Dement, William C.

doi:10.1016/0014-4886(78)90040-7

Cited by 192 publications

(60 citation statements)

References 7 publications

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“…Fibreoptic studies during obstructive apnoeas have shown abrupt collapse of the airway at the onset of inspiration, with opposition of the lateroposterior oropharyngeal walls in the pharynx and no evidence of glottic obstruction [84]. On lateral fluoroscopy [17], upper airway obstruction during inspiration is seen when the soft palate touches the posterior pharyngeal wall and the tongue.…”

Section: Mechanical Factorsmentioning

confidence: 99%

“…Defects in such upper airway muscle responses, or inco-ordination of upper airway and diaphragm activity, have each been proposed as factors predisposing to OSA [54,107,108,110,113,114]. The complexity of the upper airway makes it unlikely that dysfunction of a single muscle group is responsible for OSA [104], and thus assessment of activity of any single muscle may not be a reliable index of upper airway obstruction [84].…”

Section: Upper Airway Dilator Muscle Activitymentioning

confidence: 99%

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Pathophysiology of obstructive sleep apnoea

Deegan¹,

McNicholas²

1995

Eur Respir J

262

183

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Arousal plays an important role in the termination of each apnoea, but may also contribute to the development of further apnoea, because of a reduction in respiratory drive related to the hypocapnia which results from postapnoeic hyperventilation. A cyclical pattern of repetitive obstructive apnoeas may result.A better understanding of the integrated pathophysiology of OSA should help in the development of new therapeutic techniques.

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Section: Mechanical Factorsmentioning

confidence: 99%

Section: Upper Airway Dilator Muscle Activitymentioning

confidence: 99%

Pathophysiology of obstructive sleep apnoea

Deegan¹,

McNicholas²

1995

Eur Respir J

262

183

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“…These transient arrests may be due to either central apnoea (a complete cessation of the activity of all the respiratory muscles), obstructive apnoea (cessation of the activity of the respiratory muscles of the upper airways but persistence of the activity of the chest respiratory muscles) or mixed apnoea (a combination of both types). In the case of obstructive apnoea, a partial or total invagination of the posterolateral pharyngeal walls was described, along with a significant decrease in, or the complete disappearance of, EMG activity of several muscles in the upper airways including those innervated by the XII, particularly the genioglossus (Guilleminault, Hill, Simmons & Dement, 1978). Despite the fact that the precise locus of upper airway closure has not yet been systematically identified and may vary from one patient to another (Guilleminault et al 1978;Remmers, 1984), any inadequacy of the inspiratory upper airway muscles to overcome the negative pressure generated in the airway by the inspiratory pump muscles will favour the occurrence of obstructive apnoea (Sauerland & Harper, 1976;Remmers et al 1978;Iscoe, 1988).…”

Section: Indirect Effectsmentioning

confidence: 99%

“…In the case of obstructive apnoea, a partial or total invagination of the posterolateral pharyngeal walls was described, along with a significant decrease in, or the complete disappearance of, EMG activity of several muscles in the upper airways including those innervated by the XII, particularly the genioglossus (Guilleminault, Hill, Simmons & Dement, 1978). Despite the fact that the precise locus of upper airway closure has not yet been systematically identified and may vary from one patient to another (Guilleminault et al 1978;Remmers, 1984), any inadequacy of the inspiratory upper airway muscles to overcome the negative pressure generated in the airway by the inspiratory pump muscles will favour the occurrence of obstructive apnoea (Sauerland & Harper, 1976;Remmers et al 1978;Iscoe, 1988). These respiratory disorders may be serious in obese adults, who can suffer from recurrent obstructive apnoea leading to hypoxaemia and sleep deprivation due to frequent arousals during airway collapses.…”

Section: Indirect Effectsmentioning

confidence: 99%

Compared effects of serotonin on cervical and hypoglossal inspiratory activities: an in vitro study in the newborn rat.

Morin

Monteau

Hilaire

1992

The Journal of Physiology

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SUMMARY1. Experiments were performed on the brain stem-spinal cord preparation of newborn rats, in which the phrenic and hypoglossal nerves continue to show rhythmic respiratory activity in vitro, in order to compare the effects of serotonin (5-HT) on both activities and to analyse the mechanisms responsible for the depression by 5-HT of the hypoglossal activity.2. Under control conditions, simultaneous recordings of the inspiratory discharges of hypoglossal and cervical roots showed that the two bursts did not start simultaneously and had different patterns (time-to-peak and peak values); this suggests that both pools of motoneurons did not share the same central drive(s).3. Adding 5-HT and related agents to the bathing medium delayed and depressed the hypoglossal inspiratory discharge via activation of 5-HT2 receptors since these effects were elicited by 5-HT2 agonists (a-methyl-5-HT and 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane-HCl (DOI)) but not by 5-HT1 agonists (RU 24969 and (± )-8-hydroxy-2-(di-N-propylamino)tetralin hydrobromide (8-OH-DPAT)). The 5-HT depression of the hypoglossal discharge was prevented by applying a pretreatment with a specific 5-HT2 antagonist (ketanserin). Parallel to the hypoglossal discharge decrease, 5-HT elicited a permanent cervical root discharge along with a persistent inspiratory bursting. Adding the 5-HT precursor L-tryptophan to the bathing medium depressed the hypoglossal (XII) discharge without affecting the cervical one.4. Local application of 5-HT within the hypoglossal motor nucleus decreased the hypoglossal output, revealing that the 5-HT depression of the hypoglossal discharge was at least partly mediated by the 5-HT effects at the level of the motoneurons. Local application of 5-HT within the cervical motor nucleus elicited a permanent firing in the cervical root with a persistent inspiratory bursting.5. Intracellular analysis confirmed the existence of differences in central respiratory drive between cervical and hypoglossal motoneurons under control conditions, as well as differences in response to 5-HT. All the hypoglossal motoneurons became silent under 5-HT bathing, and showed no change in the input membrane resistance, a moderate depolarization, and a delayed central respiratory MS 9503 D. MORIN, R. MONTEA U AND 0. HILAIRE drive with a decreased amplitude. The cervical motoneurons became more active during inspiration, despite a decrease in the amplitude of the central respiratory drive, which was compensated for by a large depolarization and an increased input membrane resistance. Some cervical motoneurons even fired at a low rate during expiration.6. Taken as a whole, these results suggest that the hypoglossal depression induced by 5-HT was due to the activation of 5-HT2 receptors located within the hypoglossal nucleus but the exact mechanisms whereby 5-HT modulates the hypoglossal outputs are still open to debate. The functional significance of the effects of 5-HT on hypoglossal inspiratory activity is discussed with reference to the obstructive apno...

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“…It is the posterior and lateral walls that collapse in apneic individuals. [18][19][20] Turbulence in the pharynx causes an increase in the velocity of air, with a lowering of surrounding pressure (the Bernoulli effect), which elevates the soft tissue structure into the narrowed space and closes the airway. 21 It is the inspiratory activation of the muscles in the A-P plane, including the genioglossus, that stabilizes and dilates the airway anteriorly.…”

Section: Introductionmentioning

confidence: 99%

The relationship of vertical skeletofacial morphology to oropharyngeal airway shape using cone beam computed tomography: Possible implications for airway restriction

Haskell¹,

Haskell

Spoon

et al. 2013

The Angle Orthodontist

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Objective: To determine if the shape of the oropharyngeal airway is related to the vertical morphology of the skeletofacial complex, including the hyoid bone. Materials and Methods: Cone beam computed tomography scans from 50 pretreatment adult orthodontic records were used to obtain skeletal and airway measurements. Linear regression statistics were used to compare soft tissue variables to hard tissue predictor variables. Results: Transverse airway widening was significantly increased when the distance between the hyoid and vertebrae was reduced; when the three-dimensional (3D) facial axis angle decreased (became more vertical); when the 3D mandibular plane angle increased; when the width of the hyoid increased, or when the calculated length of the geniohyoid decreased. Conclusions: A laterally elliptical airway-found when the face is more vertical and when the hyoid is closer to the cervical vertebrae-is hypothetically more resistant to collapse. Patients with a retrognathic, skeletal deep bite and a rounded oropharynx should be identified and corrected early to prevent potential airway problems. (Angle Orthod. 2014;84:548-554.)

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Obstructive sleep apnea: Electromyographic and fiberoptic studies

Cited by 192 publications

References 7 publications

Pathophysiology of obstructive sleep apnoea

Pathophysiology of obstructive sleep apnoea

Compared effects of serotonin on cervical and hypoglossal inspiratory activities: an in vitro study in the newborn rat.

The relationship of vertical skeletofacial morphology to oropharyngeal airway shape using cone beam computed tomography: Possible implications for airway restriction

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