Assessment of Upper Airway Mechanics Using Newer EMG Techniques

项目主任/首席调查员(最后、第一、中间)：马里兰州阿图尔的马尔霍特拉 项目总结(见说明)： 近期目标：将新的肌电技术应用于上呼吸道肌肉，以期 寻找阻塞性睡眠呼吸暂停的重要治疗靶点。职业发展目标： 为学员的辅导和研究活动提供充足的时间。研究项目：阻碍性 睡眠呼吸暂停是一种重要的疾病，因为它的高患病率和成熟的神经认知和 心血管后遗症。这种疾病的治疗仍然存在问题，因为现有的治疗方法是 要么耐受性差，要么疗效不稳定，导致许多人倡导进一步研究 潜在的机制。先前的研究已经证实了上呼吸道肌肉的重要性 (如颧舌肌和腭张肌)与睡眠呼吸暂停的发病机制。但是，多个单元 肌电记录提供了无数运动单位的平均表示，相当地屈服 关于单个机动单位行为的不完整信息。我们已经开始了一系列的研究 使用肌电的高频采样来确定不同的运动单位 颧舌肌。这些较新的研究揭示了动物行为的显著复杂性 颧舌肌，可辨认出6种不同的放电模式。膝舌骨的升降 因此，多单位肌电很难解释，因为这些变化可能由多种因素中的任何一种调节 各机动部队发射情况发生变化。我们观察到的特定单位可能对 保持咽部通畅。这样的单位将因此我们合理的治疗目标，我们可以 与我们的神经解剖学合作者一起演讲。我们还开始了使用单纤维肌电图仪和 宏观肌电图，以期对各种上呼吸道进行更多的定量评估 肌肉。这些较新的肌电技术将使我们能够评估高水平的 睡眠呼吸暂停患者的肌电活动与对照组相比，因为目前有一种 关于这种高活动量是否代表着肌肉的高度中枢动力与 去神经的影响。这个K24奖将允许我们追寻有趣的假设，这些假设最终可能 为睡眠呼吸暂停症带来新的治疗方法，但肯定会对疾病的发病机制产生深刻的影响。这 该奖项还将允许PI将更多的时间用于培训年轻的调查人员在睡眠和 呼吸生理学。对调查人员管道的需要被称为一场危机(睡眠)。200629：1260) 相关性(请参阅说明)： 阻塞性睡眠呼吸暂停与机动车事故以及高血压和 卒中。一个人从睡眠中醒来的容易程度(唤醒阈值)可能是很重要的 为什么会发生睡眠呼吸暂停。我们建议进行一项研究，该研究将用一种 最终目标是开发睡眠呼吸暂停的新疗法，以预防其严重并发症。 项目/

Program Director/Principal Investigator (Last, First, Middle): Malhotra, Atul, MD PROJECT SUMMARY (Seeinstructions): Immediate goals: To apply newer electromyographic techniques to upper airway muscles with a view towards identifying important therapeutic targets in obstructive sleep apnea. Career development goals: To provide sufficient time for mentoring of trainees and research activities. Research project: Obstructive sleep apnea is an important disease due to its high prevalence and well established neurocognitive and cardiovascular sequelae. Treatment of this disease remains problematic since the existing therapies are either poorly tolerated or have variable efficacy, leading many to advocate for further research into underlying mechanisms. Prior research has established in the importance of the upper airway muscles (such as the genioglossus and tensor palatini) in the pathogenesis of sleep apnea. However, multi-unit electromyographic recordings provide an average representation of innumerable motor units yielding fairly incomplete information about the behavior of individual motor units. We have begun a series of studies using high frequency sampling of the electromyogram to define the various motor units within the genioglossus muscle. These newer studies have revealed marked complexity in the behavior of the genioglossus muscle, with 6 distinct firing patterns being identifiable. A rise or fall in the genioglossal multiunit EMG is therefore difficult to interpret since these changes could be mediated by any of a number of individual motor unit firing changes. We have observed specific units that may be most critical for the maintenance of pharyngeal patency. Such units would thus we logical therapeutic targets which we can address with our neuroanatomy collaborators. We have also begun studies using single fiber EMGs and MacroEMGs which a view towards performing more quantitative assessments of various upper airway muscles. These newer EMG techniques will allow us to assess the mechanisms underlying the high level of activity seen in the EMG of sleep apnea patients as compared with controls, since there is currently an ongoing controversy as to whether this high activity represents high central drive to the muscle versus an effect of denervation. This K24 award would allow us to pursue interesting hypotheses that may ultimately lead to new treatments for sleep apnea, but will certainly yield insights into disease pathogenesis. This award will also allow the PI to dedicate more time to training young investigators in the field of sleep and respiratory physiology. The need for an investigator pipeline has been termed a crisis (Sleep. 2006 29:1260) RELEVANCE (See instructions): Obstructive sleep apnea is strongly implicated in motor vehicle accidents as well as high blood pressure and stroke. How easily an individual wakes up from sleep (arousal threshold) is something that may be important in why sleep apnea occurs. We propose studies that will examine the role of the arousal threshold with an ultimate goal of developing new treatments for sleep apnea to prevent its serious complications. PROJECT/