Upper Airway Collapsibility (Pcrit) and Pharyngeal Dilator Muscle Activity are Sleep Stage Dependent
Upper Airway Collapsibility (Pcrit) and Pharyngeal Dilator Muscle Activity are Sleep Stage Dependent
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DOI：
10.5665/sleep.5516
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发表时间：
2016-03-01
期刊：
影响因子：
5.6
通讯作者：
Eckert, Danny J.
中科院分区：
文献类型：
--
作者：
Carberry, Jayne C.;Jordan, Amy S.;Eckert, Danny J.
研究目的：解剖学上狭窄/高度塌陷的上气道是阻塞性睡眠呼吸暂停（OSA）的主要原因。上气道肌肉活动有助于气道通畅，并且与呼吸暂停严重程度一样，可以依赖于睡眠阶段。相反，来自少数参与者的现有数据表明，通过被动咽临界闭合压（Pcrit）技术测量的上气道可膨胀性不依赖于睡眠阶段。本研究旨在确定Pcrit和上呼吸道肌肉活动在一个更大的队列比以前tested.Methods：Pcrit和/或肌肉的数据，从72个成年人年龄在20-64岁，有和没有OSA的睡眠阶段的效果。通过N2、慢波睡眠（SWS）和快速眼动（REM）睡眠期间持续气道正压通气（CPAP）的短暂降低来确定Pcrit。测量颏舌肌和腭张肌的活动：（1）清醒时有和没有CPAP，（2）在CPAP稳定睡眠期间，以及（3）对用于量化Pcrit的CPAP减少的反应。Pcrit高出4.9 +/- 1.4 cmH（2）O REM与SWS期间（更可折叠）（P = 0.012），REM期间比N2高2.3 +/- 0.6 cmH（2）O（P < 0.001），N2中比SWS高1.6 +/- 0.7 cmH（2）O（P = 0.048）。颏舌肌的肌肉活动从清醒到睡眠，从SWS到N2到REM睡眠，而不是腭张肌。咽部肌肉活动增加了类似呼吸5以下CPAP reductions.Conclusions：上呼吸道呼吸能力通过Pcrit技术和颏舌肌活动测量随睡眠阶段而变化。在进行和解释“被动”Pcrit测量时，应考虑这些结果。
Study Objectives: An anatomically narrow/highly collapsible upper airway is the main cause of obstructive sleep apnea (OSA). Upper airway muscle activity contributes to airway patency and, like apnea severity, can be sleep stage dependent. Conversely, existing data derived from a small number of participants suggest that upper airway collapsibility, measured by the passive pharyngeal critical closing pressure (Pcrit) technique, is not sleep stage dependent. This study aimed to determine the effect of sleep stage on Pcrit and upper airway muscle activity in a larger cohort than previously tested.Methods: Pcrit and/or muscle data were obtained from 72 adults aged 20-64 y with and without OSA. Pcrit was determined via transient reductions in continuous positive airway pressure (CPAP) during N2, slow wave sleep (SWS) and rapid eye movement (REM) sleep. Genioglossus and tensor palatini muscle activities were measured: (1) awake with and without CPAP, (2) during stable sleep on CPAP, and (3) in response to the CPAP reductions used to quantify Pcrit.Results: Pcrit was 4.9 +/- 1.4 cmH(2)O higher (more collapsible) during REM versus SWS (P = 0.012), 2.3 +/- 0.6 cmH(2)O higher during REM versus N2 (P < 0.001), and 1.6 +/- 0.7 cmH(2)O higher in N2 versus SWS (P = 0.048). Muscle activity decreased from wakefulness to sleep and from SWS to N2 to REM sleep for genioglossus but not for tensor palatini. Pharyngeal muscle activity increased by similar to 50% by breath 5 following CPAP reductions.Conclusions: Upper airway collapsibility measured via the Pcrit technique and genioglossus muscle activity vary with sleep stage. These findings should be taken into account when performing and interpreting "passive" Pcrit measurements.