Oliven A, Schnall R P, Pillar G, Gavriely N, Odeh M
Department of Internal Medicine B, Bnai Zion Medical Center, Golomb Str. 47, 31048, Haifa, Israel.
Respir Physiol. 2001 Sep;127(2-3):217-26. doi: 10.1016/s0034-5687(01)00254-7.
Pharyngeal obstruction in patients with obstructive sleep apnea (OSA) is thought to result from decreased upper airway muscle tone during sleep. The goal of the present study was to estimate the role of the tongue muscles in maintaining pharyngeal patency during sleep. Using non-invasive, sub-lingual surface electrical stimulation (ES), we measured tongue protrusion force during wakefulness and upper airway resistance during sleep in seven healthy subjects and six patients with OSA. During wakefulness, ES produced similar protrusion forces in healthy subjects and patients with OSA. ES of the anterior sublingual surface, causing preferential contraction of the genioglossus, resulted in smaller effects than combined ES of the anterior and lateral surface, which also stimulated tongue retractors. During sleep, trans-pharyngeal resistance decreased and peak inspiratory flow rate increased from 319+/-24 to 459+/-27 and from 58+/-16 to 270+/-35 ml/sec for healthy subjects and OSA patients, respectively (P<0.001). However, ES was usually unsuccessful in reopening the upper airway in the presence of complete apneas. We conclude that non-invasive ES of the tongue improves flow dynamics during sleep. Combined activation of tongue protrusors and retractors may have a beneficial mechanical effect. The magnitude of responses observed suggests that in addition to the stimulated muscles, other muscles and/or forces have a substantial impact on pharyngeal patency.
阻塞性睡眠呼吸暂停（OSA）患者的咽部阻塞被认为是由于睡眠期间上气道肌肉张力降低所致。本研究的目的是评估舌肌在睡眠期间维持咽部通畅中的作用。我们对7名健康受试者和6名OSA患者，采用非侵入性舌下表面电刺激（ES），测量了清醒时的舌前突力和睡眠时的上气道阻力。在清醒状态下，ES在健康受试者和OSA患者中产生的前突力相似。舌下前表面的ES主要引起颏舌肌收缩，其效果小于前表面和外侧表面联合ES，后者还刺激了舌回缩肌。在睡眠期间，健康受试者和OSA患者的经咽阻力降低，吸气峰值流速分别从319±24增加到459±27以及从58±16增加到270±35 ml/秒（P<0.001）。然而，在完全性呼吸暂停的情况下，ES通常无法重新打开上气道。我们得出结论，舌的非侵入性ES可改善睡眠期间的气流动力学。舌前突肌和回缩肌的联合激活可能具有有益的机械作用。观察到的反应程度表明，除了受刺激的肌肉外，其他肌肉和/或力量对咽部通畅也有重大影响。
