Control of the pharyngeal musculature during wakefulness and sleep: Implications in normal controls and sleep apnea

Abstract

Respiration involves the complex coordination of several pump and upper airway/pharyngeal muscles. From a respiratory perspective, the major function of the pharyngeal muscles is to keep the airway patent allowing for airflow in and out of the lung with minimal work by the respiratory pump muscles. The activity of each of the pharyngeal muscles varies depending on its function, but many reduce their activity during sleep. In healthy individuals, these muscles can respond to respiratory stimuli during sleep in order to prevent airway collapse. However, in individuals with an anatomically small airway, the muscles cannot always compensate for the increased mechanical load. Thus, a vulnerable situation in which the airway is prone to collapse may occur with the development of obstructive sleep apnea (OSA). The present article describes the current understanding regarding the control of the pharyngeal musculature during wakefulness and sleep, as well as the implications for OSA.

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

“…The GGM has an electromyogram (EMG) activity that is typically inspiratory phasic (greater activity on inspiration), and functions as a dilator of the pharyngeal airway. Meanwhile, tensor palatini activity is typically more constant (tonic) throughout the respiratory cycle [57,58].…”

“…As a result, tensor palatini activity is commonly quite low during sleep, despite elevations in both upper airway resistance and arterial carbon dioxide tension. The drive to several pharyngeal muscles appears to be reduced during sleep, as does their responsiveness to both chemical and mechanical stimuli [57]. Other studies have pointed to changes in respiratory timing and GGM activity during partial upper airway collapse; however, despite such activation, obese patients with OSA could restore airflow and ventilation less often than nonsnorers [60].…”

Anatomical Insight into the Muscle Petropharyngeus-a Supernumerary Muscle of the Posterior Pharyngeal Wall

“…This might have a role in obstructive sleep apnoea, abnormal swallowing, pharyngeal clearance, speech, respiratory modulation, dysphagia, cancer, pharyngeal reconstruction, pharyngoplasty etc. [2,4,7,10,[20][21][22][23]. Understanding the normal/abnormal anatomy and physiology of eating and swallowing is the fundamental keystone in evaluating and treating disorders, pertinent to the region and in developing programs for dysphagia rehabilitation.…”

“…These muscles also exhibit a mechanical effect that depends on the lung volume. At high lung volumes they act as constrictors but at low lung volumes they act as dilators [7]. The pharyngeal muscular wall is stated to be surprisingly thin.…”

Efeitos da terapia miofuncional orofacial em pacientes com ronco primário e apneia obstrutiva do sono na anatomia e função da via aérea

“…A musculatura da VAS será subdividida em grupos para melhor compreensão. [27] Os músculos do palato são cinco: elevador do palato, tensor do palato, palatoglosso, [27] Os músculos constritores da faringe são constritor superior, constritor médio e constritor inferior, os quais atuam na constrição da faringe para auxiliarem a deglutição. [27] Os músculos denominados extrínsecos da língua são três (genioglosso, hioglosso e estiloglosso) (Figura 1) e controlam sua posição.…”