The Role of Vascular Tone in the Control of Upper Airway Collapsibility

Wasicko, M. J.; Hutt, Douglas A.; Parisi, Richard A.; Neubauer, Judith A.; Mezrich, Reuben; Edelman, Norman H.

doi:10.1164/ajrccm/141.6.1569

Cited by 79 publications

(41 citation statements)

References 6 publications

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“…Thus, it is plausible that vasodilatation and increased vascular perfusion also occur in vessels supplying the pharyngeal airway during REM sleep leading to a decreased airway compliance. It should be noted, however, that in other studies the changes in vascular tone were associated with changes in baseline pharyngeal CSA (Wasicko, Hutt, Parisi, Neubauer, Mezrich & Edelman, 1990;Shepard et al 1996), which we did not observe. Thus, we propose that the differences in compliance between REM and NREM sleep were secondary to an increased perfusion of the upper airway during REM sleep.…”

Section: The Effect Of Rem Sleep On the Upper Airwaycontrasting

confidence: 96%

The effect of rapid eye movement (REM) sleep on upper airway mechanics in normal human subjects

Rowley

Zahn

Babcock

et al. 1998

The Journal of Physiology

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It has been proposed that the upper airway is more compliant during rapid eye movement (REM) sleep than during non‐rapid eye movement (NREM) sleep. The purpose of this study was to test this hypothesis in a group of subjects without sleep‐disordered breathing. On the first night, the effect of sleep stage on the relationship of retropalatal cross‐sectional area (CSA; visualized with a fibre‐optic scope) to pharyngeal pressure (PPH) measured at the soft palate during eupnoeic breathing was studied. Breaths during REM sleep were divided into phasic (associated with eye movements) and tonic (not associated with eye movements). There was a significant decrease in pharyngeal CSA during NREM sleep compared with wakefulness. There was no further decrease observed during either tonic or phasic REM sleep. Pharyngeal compliance, defined as the slope of the regression CSA versus PPH, was significantly increased during NREM sleep compared with wakefulness and REM sleep, with the compliance during both tonic and phasic REM sleep being similar to that observed in wakefulness. On the second night, the effect of sleep stage on pressure‐flow relationships of the upper airway was investigated. There was a trend towards the upper airway resistance being highest in NREM sleep compared with wakefulness and REM sleep. We conclude that the upper airway is stiffer and less compliant during REM sleep than during NREM sleep. We postulate that this difference is secondary to differences in upper airway vascular perfusion between REM and NREM sleep.

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Section: The Effect Of Rem Sleep On the Upper Airwaycontrasting

confidence: 96%

The effect of rapid eye movement (REM) sleep on upper airway mechanics in normal human subjects

Rowley

Zahn

Babcock

et al. 1998

The Journal of Physiology

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“…22 Patients were excluded if they were nonadherent to prescribed drug treatment (self-report), had a correctable secondary form of hypertension, ingested exogenous substances (including alcohol) that can raise BP (current or in previous 2 weeks), had symptomatic heart failure with a left ventricular ejection fraction Ͻ50%, or were symptomatic from coronary artery disease requiring nitrates. 23 Otherwise, if applicable, nitrates and phosphodiesterase-5 inhibitors 24 were withheld for 2 weeks before study enrollment.…”

Section: Subjectsmentioning

confidence: 99%

Relationship Between Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Drug-Resistant Hypertension

et al. 2010

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Abstract-Obstructive sleep apnea occurs frequently in patients with drug-resistant hypertension. The factors accounting for this observation, however, are unclear. Both conditions demonstrate clinical features suggestive of extracellular fluid volume overload. The aims of this study were to examine whether the spontaneous overnight fluid shift from the legs to the upper body is associated with obstructive sleep apnea in hypertensive subjects and whether its magnitude is greater in drug-resistant hypertension. Leg fluid volume and the circumference of the calf and neck were measured before and after sleep in drug-resistant hypertensive (nϭ25) and controlled hypertensive (nϭ15) subjects undergoing overnight polysomnography. The severity of obstructive sleep apnea was greater in the drug-resistant hypertensive group than in the controlled hypertensive group (apnea-hypopnea index: 43.0Ϯ5.4 versus 18.1Ϯ4.2 events per hour of sleep; Pϭ0.02, case-mix adjusted). In both groups, the apnea-hypopnea index strongly related to the amount of leg fluid volume displaced (R 2 ϭ0.56; PϽ0.0001), although the magnitude of change was greater in the drug-resistant hypertensive group (346.7Ϯ24.1 versus 175.8Ϯ31.3 mL; Pϭ0.01, propensity-score adjusted). The overnight reduction in calf circumference and increase in neck circumference were also greater in drug-resistant hypertension (both PՅ0.02). In hypertensive subjects, rostral fluid displacement strongly relates to the severity of obstructive sleep apnea with its magnitude being greater in drug-resistant hypertension. Our findings support the concept that fluid redistribution centrally during sleep accounts for the high prevalence of obstructive sleep apnea in drug-resistant hypertension. rug-resistant hypertension (DRH) is emerging as a major and growing problem in managing hypertension. It accelerates the atherosclerotic burden of aging and is associated with a significant increased risk of hypertensive target organ damage. 1 In a previous study, we reported that patients with DRH had a very high prevalence of obstructive sleep apnea (OSA) 2 and subsequently demonstrated that treatment of OSA with continuous positive airway pressure was accompanied by a significant fall in both nighttime and daytime blood pressure (BP). 3 Obesity is associated both with decreased responsiveness to antihypertensive medications 4 and with OSA. 5 Whether obesity is the factor that explains the association between DRH and OSA, however, is unclear, because increased body weight and neck girth only account for approximately one third of the variability in the frequency of apneas and hypopneas per hour of sleep (ie, the apneahypopnea index [AHI]). 6 Moreover, the factors accounting for weight-related antihypertensive drug resistance have not been identified.Many studies have demonstrated abnormalities in extracellular fluid volume regulation in DRH and OSA. Plasma renin is generally suppressed in both conditions, 7,8 and primary aldosteronism is a common finding in DRH. 9 BP of DRH patients often falls dr...

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“…The estimated prevalence of this syndrome in general population is 2% in women and 4% in men ( 1). Upper airway (UA) collapsibility is increased in SAHS patients (2); this can be accounted for by several factors, such as a decrease in UA caliber (3), changes in mucosal characteristics (4), or changes in the lung-volume dependence of UA patency (5). UA collapse results from an imbalance between the forces that tend to occlude UA (negative transmural inspiratory pharyngeal gradient), and those that open it, such as the contraction of UA dilator muscles (6).…”

Section: Introductionmentioning

confidence: 99%

Physiologic, metabolic, and muscle fiber type characteristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers.

Sériès¹,

Côté²,

Simoneau³

et al. 1995

J. Clin. Invest.

147

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Upper airway dilator muscles play an important role in the pathophysiology of sleep apnea hypopnea syndrome (SAHS). The mechanical and structural characteristics of these muscles remain unknown. The aim of this study was to compare the physiologic, metabolic, and fiber type characteristics of one upper airway dilator muscle (musculus uvulae, MU) in 11 SAHS and in seven nonapneic snorers. The different analyses were done on MU obtained during uvulo-palato-pharyngoplasty. Snorers and SAHS differed only in their apnea + hypopnea indices (11.5±5.9 and 34.2±14.6/h, respectively, mean±SD). Absolute twitch and tetanic tension production of MU was significantly greater in SAHS than in snorers while the fatigability index was similar in the two groups. Protein content and anaerobic enzyme activities of MU were signillcantly greater in SAHS than in snorers; no difference was observed for aerobic enzyme activities. The total muscle fiber cross-sectional area of MU was signfficantly higher in SAHS (2.2±0.9 mm') than in snorers (1.1±0.7 mm2). The surface occupied by type HIA muscle fibers of MU was larger in SAHS (2.00±0.96) than in snorers (0.84±0.63 nu2). We conclude that the capacity for tension production and the anaerobic metabolic activity of MU are greater in SAHS than in snorers. (J. Clin. Invest. 1995. 95:20-25.) Key words: upper airway collapsibility . upper airway dilator muscle * muscle fatigue, muscle fiber area * metabolic profile * human skeletal muscle

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The Role of Vascular Tone in the Control of Upper Airway Collapsibility

Cited by 79 publications

References 6 publications

The effect of rapid eye movement (REM) sleep on upper airway mechanics in normal human subjects

The effect of rapid eye movement (REM) sleep on upper airway mechanics in normal human subjects

Relationship Between Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Drug-Resistant Hypertension

Physiologic, metabolic, and muscle fiber type characteristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers.

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