Modulation of upper airway collapsibility during sleep: influence of respiratory phase and flow regimen
Modulation of upper airway collapsibility during sleep: influence of respiratory phase and flow regimen
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DOI：
10.1152/japplphysiol.00942.2001
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发表时间：
2002-10-01
影响因子：
3.3
通讯作者：
Schwartz, AR
中科院分区：
文献类型：
--
作者：
Schneider, H;Boudewyns, A;Schwartz, AR
我们假设，上呼吸道可膨胀性在睡眠中的人的呼吸周期中通过呼吸相位和/或气流方案的改变而动态调节。为了验证这一假设，临界压力来自上气道压力-流量的关系，在六个气管切开阻塞性睡眠呼吸暂停患者。通过分别在气管切开术（吸气和呼气）（比较A）和鼻（仅吸气）呼吸（比较B）期间改变气管和鼻处的压力来产生压力-流量关系。当在整个呼吸周期中维持恒定的气流方案时，（气管切开术呼吸），在吸气与呼气末和呼气峰时间点发现临界压力有小而显著的降低[分别为7.1 +/- 1.6（SE）至6.6 +/- 1.9至6.1 +/- 1.9 cmH（2）O; P < 0.05]，表明时相因素对上气道通透性的影响不大。相反，我们发现经鼻呼吸与气管切开呼吸相比，吸气临界压力显著下降[1.1 +/- 1.5（SE）vs. 6.1 +/- 1.9 cmH（2）O; P < 0.01]，表明上气道可膨胀性受气流方案差异的显著影响。气管切开术呼吸也与睡眠时颏舌肌的阶段性和紧张性活动减少有关。我们的研究结果表明，阶段性因素和气流方案动态调节上气道可膨胀性，并表明神经肌肉对气流方案改变的反应可以显着降低吸气时的上气道可膨胀性。
We hypothesized that upper airway collapsibility is modulated dynamically throughout the respiratory cycle in sleeping humans by alterations in respiratory phase and/or airflow regimen. To test this hypothesis, critical pressures were derived from upper airway pressure-flow relationships in six tracheostomized patients with obstructive sleep apnea. Pressure-flow relationships were generated by varying the pressure at the trachea and nose during tracheostomy (inspiration and expiration) (comparison A) and nasal (inspiration only) breathing (comparison B), respectively. When a constant airflow regimen was maintained throughout the respiratory cycle (tracheostomy breathing), a small yet significant decrease in critical pressure was found at the inspiratory vs. end- and peak-expiratory time point [7.1 +/- 1.6 (SE) to 6.6 +/- 1.9 to 6.1 +/- 1.9 cmH(2)O, respectively; P < 0.05], indicating that phasic factors exerted only a modest influence on upper airway collapsibility. In contrast, we found that the inspiratory critical pressure fell markedly during nasal vs. tracheostomy breathing [1.1 +/- 1.5 (SE) vs. 6.1 +/- 1.9 cmH(2)O; P < 0.01], indicating that upper airway collapsibility is markedly influenced by differences in airflow regimen. Tracheostomy breathing was also associated with a reduction in both phasic and tonic genioglossal muscle activity during sleep. Our findings indicate that both phasic factors and airflow regimen modulate upper airway collapsibility dynamically and suggest that neuromuscular responses to alterations in airflow regimen can markedly lower upper airway collapsibility during inspiration.