Collapsibility of the human upper airway during normal sleep

Wiegand, Laurel; Zwillich, Clifford W.; White, David P.

doi:10.1152/jappl.1989.66.4.1800

Cited by 104 publications

(83 citation statements)

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“…Thus, there was no additional effect of REM sleep on baseline retropalatal dimensions. This finding is corroborated by previous studies which have found that upper airway resistance during REM sleep was the same (Hudgel et al 1984;Wiegand et al 1989) or less than (Wiegand et al 1990a) that seen during NREM sleep. Our study also showed a similar finding, with a trend for the RUA at a fixed flow of 0·1 l s¢ to be less during REM sleep than during NREM sleep.…”

Section: The Effect Of Rem Sleep On the Upper Airwaysupporting

confidence: 89%

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 Airwaysupporting

confidence: 89%

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

View full text Add to dashboard Cite

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“…A sleepinduced increase in upper airway resistance, in the absence of immediate load compensation, seems to be an important determinant of CO 2 retention [44]. The changes in upper airway resistance, observed in normal subjects, may be quite variable [45]. The higher the CO 2 apnoeic threshold, the more central apnoeas will occur during sleep.…”

Section: Co 2 Thresholdmentioning

confidence: 99%

Central sleep apnoea, pathogenesis and treatment: an overview and perspective

Backer

1995

Eur Respir J

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C Ce en nt tr ra al l s sl le ee ep p a ap pn no oe ea a, , p pa at th ho og ge en ne es si is s a an nd d t tr re ea at tm me en nt t: : a an n o ov ve er rv vi ie ew w a an nd d p pe er rs sp pe ec ct ti iv ve e There is accumulating evidence that central sleep apnoea should be considered as the end of a spectrum. Instability in the breathing pattern is the main underlying mechanism and is due to the interaction of many factors. Breathing during sleep is dependent on metabolic control and the activity of the respiratory muscles. Treatment strategies are remarkably few in number. Use of nasal ventilation and the inhalation of CO 2 are mainly of theoretical interest, since patients do not often tolerate these more invasive therapies. Drug treatment, especially with acetazolamide, is easier to perform. Stimulation of upper airway reflexes, by less invasive methods, seems to be promising for the near future.

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“…[17][18][19] Ethanol has been shown to increase both waking and sleeping upper airway resistance. Robinson and associates 20 showed that the same dose of ethanol used in our study increased the upper airway resistance of healthy waking subjects by about 75% at 45 min after the drink and that the resistance was back to near the baseline level at 90 min.…”

Section: Effects On Airway Resistancementioning

confidence: 99%

Effect of Bedtime Ethanol on Total Inspiratory Resistance and Respiratory Drive in Normal Nonsnoring Men

Dawson

Lehr

Bigby

et al. 1993

Alcoholism Clin & Exp Res

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We have previously reported that bedtime ethanol (2.0 ml/kg of 100 proof vodka) increases upper airway closing pressure in males who habitually snored but were otherwise healthy. We also observed that some of these snorers developed obstructive apneas. To explore this phenomenon in more detail, we measured the inspiratory resistance (R 1 ) and respiratory drive after bedtime ethanol in 10 nonobese men (ages 23 to 33) with no history of snoring. Subjects went to bed wearing a tightly fitting valved mask over the nose and mouth that allowed measurement of inspiratory and expiratory flow, pressure in the mask, and endtidal CO 2 . We measured R 1 by calculating the pressure difference between the mouth and a balloon positioned in the midesophagus. Respiratory drive was quantified by the inspiratory occlusion pressure (P 0.1 ), the ventilatory response to hyperoxic hypercapnia (ΔV̇E/ΔP ET CO 2 ), and the ventilatory response to isocapnic hypoxia (ΔV̇E/ΔS a O 2 ). Measurements were made during waking and during stage 2 NREM sleep on two nights: (1) when the subjects drank 1.5 ml/kg of 100 proof vodka in orange juice over a 30-min period 15-45 min before lights out and (2) when the orange juice contained less than 0.1 ml of vodka floating on the top. Eight of the nine men in whom we had technically adequate measurements showed a rise in R 1 during NREM sleep above the waking level on both control and ethanol nights and the sleeping R 1 was greater on the ethanol than on the control night. There was a tendency for P 0.1 to be higher during sleep and greater on the ethanol night, suggesting that the neural output to the respiratory muscles was not depressed and may have been stimulated by the inspiratory "loading" secondary to the increased R 1 . The hypercapnic response was significantly depressed during sleep. Whereas the response tended to be less on the ethanol than on the control night, the difference was not significant. The hypoxic response showed little change from waking to sleeping and no significant change with ethanol. We speculate that inspiratory loading due to increased upper airway resistance tends to stimulate respiratory drive and thereby partially offsets the depressant effect of ethanol on the central respiratory chemoreceptors. Keywords Ethanol; Respiratory Drive; Sleep; Upper Airway ResistanceThe depressant effect of ethanol on respiratory drive has been recognized for many years. 1-4 More recently, we and others have shown that moderate doses of ethanol taken at bedtime can have another deleterious effect on respiration by increasing the upper airway resistance. Ethanol increases snoring in men who snore and worsens the severity of apneic episodes in patients with obstructive sleep apnea. 1,5-9 However, there are no data examining the effects of ethanol on inspiratory resistance in nonsnorers whose upper airway remains relatively patent during sleep. This study was done to characterize and analyze the magnitude of changes in inspiratory resistance and respiratory drive after a group of norm...

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Collapsibility of the human upper airway during normal sleep

Cited by 104 publications

References 0 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

Central sleep apnoea, pathogenesis and treatment: an overview and perspective

Effect of Bedtime Ethanol on Total Inspiratory Resistance and Respiratory Drive in Normal Nonsnoring Men

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