Capillary Supply of the Soft Palate Muscles Is Reduced in Long-Term Habitual Snorers

Stål, Per; Lindman, Rolf; Johansson, Bengt

doi:10.1159/000197975

Cited by 20 publications

(23 citation statements)

References 90 publications

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“…Previous observations of an increase in connective tissue, abnormal muscle fiber size, changes in muscle fiber phenotypes [6,7,8,9], signs of nerve injury [7,10] and inflammation [11] in upper airway muscles in patients indicate that an impaired upper airway muscle function might contribute to OSAS. Moreover, we have recently shown that the soft palate muscles in long-term snorers with OSAS have a reduced capillary supply [12]. This may cause disturbances in the microcirculation and local metabolism in the soft palate muscles and aggravate preexisting muscle dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Abnormal Mitochondria Organization and Oxidative Activity in the Palate Muscles of Long-Term Snorers with Obstructive Sleep Apnea

Stål

Johansson²

2012

Respiration

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Background: Histopathological alterations and a reduced number of capillaries have been observed in the palate muscles of snorers with obstructive sleep apnea syndrome (OSAS). These changes may create a substrate for decreased microcirculation, impaired aerobic metabolism and muscle dysfunction and contribute to upper airway obstruction during sleep. Objectives: The aim was to analyze mitochondria distribution and oxidative enzyme activity in relation to capillary supply in the palate muscles of patients with a history of long-term snoring and OSAS. Methods: Palatopharyngeus (PP) and uvula (UV) muscle samples were obtained from 8 patients undergoing uvulopalatopharyngoplasty due to habitual snoring and OSAS. The muscles were analyzed with enzyme- and immunohistochemistry and morphometry. Results: Abnormalities in the internal organization of mitochondria and oxidative activity were observed in 39 ± 15% of the fibers in the PP and 4 ± 3% in the UV, but not in control samples. The majority of these fibers had a lobulated contour and trabecular internal organization of mitochondria. The number of capillaries around abnormal fibers (PP 0.9 ± 0.3, UV 0.4 ± 0.1) was lower than in fibers of a normal appearance in both patients (PP 1.4 ± 0.6, UV 1.2 ± 0.3) and references (PP 2.7 ± 0.7, UV 1.9 ± 0.9) (p < 0.05). Conclusions: Abnormal mitochondrial distribution, a low capillary supply and signs of impaired oxidative activity suggest that muscle dysfunction of the palate muscles in long-term snorers may contribute to the upper airway obstruction during sleep. The cause of these abnormalities remains unclear, but local muscle and nerve trauma due to vibration and stretch is a possible etiology.

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Section: Introductionmentioning

confidence: 99%

Abnormal Mitochondria Organization and Oxidative Activity in the Palate Muscles of Long-Term Snorers with Obstructive Sleep Apnea

Stål

Johansson²

2012

Respiration

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“…Changes in sensation, muscle structure, and physiological properties of UA have been reported in patients with OSAS; these changes are referred to as airway remodeling. But whereas the structural and functional properties of muscles of OSAS patients have been extensively analyzed [5,[12][13][14], the motor nerve fibers and motor endplates as well as the potential role of sensory nerve impairment in OSAS have not been sufficiently investigated [15,16]. Furthermore, the available data are heterogeneous and sometimes contradictory, because of the heterogeneity of the UA muscles, the different nerves innervating these muscles and the UA mucosae, and the differences in the methods used.…”

Section: The Neurological Theory Of Osas and The Upper Airways Remodementioning

confidence: 99%

“…They include focal muscle atrophy and muscle bundle disruption [11,52], prevalence of angulated muscle fibers, increased and/or reduction of muscle fibers diameter and variation in fiber type grouping [14,23,[53][54][55][56][57], atrophic and hypertrophic muscle fibers [8,52,58], changes in mitochondria content [14], enzymatic changes [56], and increased neural cell adhesion molecule expression by muscle cells [13].…”

Section: Muscle Changes In Osasmentioning

confidence: 99%

“…Another characteristic of the UA muscles is the high percentage disproportion of glycolytic fast twitch of type II muscle fibers compared with non-OSA control subjects [12,14,55,[59][60][61][62], a difference that may represent an adaptive response to mechanical strain and/or neuronal activity. In this way, the over expression of N-CAM is suggestive of collateral nerve sprouting, reflected in the hyperinnervation that present these muscles [13].…”

Section: Muscle Changes In Osasmentioning

confidence: 99%

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Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Cobo¹,

Macías²,

Alvarez³

et al. 2017

Sleep Apnea - Recent Updates

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Obstructive sleep apnea syndrome (OSAS) is a widely diffused disease associated with specific genetics, age, gender, craniofacial and upper airways anatomy, obesity, and endocrine conditions, but not with ethnicity profiles. The so-called neurogenic neurogenic theory of OSAS postulates that the collapse of the upper airways that characterize this disease is due to peripheral nerve degeneration that leads to muscle atrophy and collapse. This review attempts to summarize the structural and functional changes in both the sensory and motor innervation of the walls of the upper air ways in patients suffering from OSAS.

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“…A vast amount of experimental evidence demonstrates that externally applied mechanical stresses (fluid shear stress, stretch, and pressure) regulate cytoskeletal organization, signal transduction, gene expression, and a wide variety of extracellular functions, including migration, proliferation, and extracellular matrix remodeling, which suggests a role of extrinsic stresses in angiogenesis [10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Molecular Response of the Human Diaphragm on Different Modes of Mechanical Ventilation

Dermitzaki¹,

Tzortzaki

Soulitzis

et al. 2012

Respiration

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Background: The mechanical stress that the human diaphragm is exposed to during mechanical ventilation affects a variety of processes, including signal transduction, gene expression, and angiogenesis. Objectives: The study aim was to assess the change in the production of major angiogenic regulators [vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF2), and transforming growth factor beta 1 (TGFB1)] on the human diaphragm before and after contraction/relaxation cycles during mechanical ventilation. Methods: This observational study investigates the diaphragmatic mRNA expression of VEGF, FGF2, and TGFB1 in surgical patients receiving general anesthesia with controlled mechanical ventilation (CMV) with muscle relaxation (group A, n = 13), CMV without muscle relaxation (group B, n = 10), and pressure support of spontaneous breathing (group C, n = 9). Diaphragmatic samples were obtained from each patient at two time points: 30 min after the induction of anesthesia (t₁) and 90 min after the first specimen collection (t₂). Results: No significant changes in the mRNA expression of VEGF, FGF2, and TGFB1 were documented in groups A and C between time points t₁ and t₂. In contrast, in group B, the mRNA levels of the above angiogenic factors were increased in time point t₂ compared to t₁, a finding which was statistically significant (p_VEGF = 0.003, p_FGF2 = 0.028, p_TGFB1 = 0.001). Conclusions: These findings suggest that the molecular response of the human diaphragm before and after application of diverse modes of mechanical ventilation is different. Angiogenesis via the expression of VEGF, FGF2, and TGFB1 was only promoted in CMV without muscle relaxation, and this may have important clinical implications.

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Capillary Supply of the Soft Palate Muscles Is Reduced in Long-Term Habitual Snorers

Cited by 20 publications

References 90 publications

Abnormal Mitochondria Organization and Oxidative Activity in the Palate Muscles of Long-Term Snorers with Obstructive Sleep Apnea

Abnormal Mitochondria Organization and Oxidative Activity in the Palate Muscles of Long-Term Snorers with Obstructive Sleep Apnea

Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Molecular Response of the Human Diaphragm on Different Modes of Mechanical Ventilation

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