Bishara H, Odeh M, Schnall R P, Gavriely N, Oliven A
Dept of Internal Medicine B, Bnai-Zion Medical Center, Technion-Hafia, Israel.
Eur Respir J. 1995 Sep;8(9):1537-42.
There is current controversy as to whether electrical stimulation of upper airway musculature can be used us a beneficial treatment modality in patients with obstructive sleep apnoea syndrome. Increased upper airway (UAW) muscle activity decreases UAW resistance (Ruaw) in isolated UAW of dogs. In the present study, we evaluated the effect of UAW muscle contraction on UAW patency in anaesthetized dogs in vivo breathing spontaneously through partially and completely obstructed UAW. Airflow and supraglottic pressure were measured to obtain Ruaw. Ruaw could be regulated by inhalation of a rubber balloon implanted transcutaneously in the pharyngeal submucosa to produce partial or complete obstruction. Wire electrodes were implanted bilaterally into the genioglossus (GG), geniohyoid (GH), sternothyroid (ST), and sternohyoid (SH) muscles for electrical stimulation (ES), and into the alae nasi for electromyographic (EMG) recording. Three levels of electrical stimulation were delivered to each muscle before and during partial or complete UAW obstruction. Genioglossus and geniohyoid stimulation both resulted in a significant reduction in Ruaw, which was most pronounced during partial obstruction, reducing Ruaw from 54 +/- 11 to 14 +/- 3 and from 74 +/- 12 to 31 +/- 5 cmH2O.L-1.s, respectively. At low voltage, stimulation of the genioglossus was more effective than stimulation of the geniohyoid in reducing Ruaw. Furthermore, electrical stimulation of the genioglossus but not of the geniohyoid released total obstruction. In contrast, electrical stimulation of the sternohyoid and sternothyroid produced no significant change in Ruaw. These findings demonstrate that selective UAW dilatory muscle contraction in spontaneously breathing anaesthetized dogs reduces Ruaw in the presence of UAW obstruction and releases UAW occlusion, with the genioglossus being the most effective muscle. This favours further attempts to investigate the benefits of electrical stimulation of selected upper airway muscles in the treatment of obstructive sleep apnoea syndrome.
对于电刺激上气道肌肉组织能否作为阻塞性睡眠呼吸暂停综合征患者的一种有益治疗方式，目前存在争议。在犬的离体上气道中，增加上气道（UAW）肌肉活动可降低上气道阻力（Ruaw）。在本研究中，我们评估了在体内经部分和完全阻塞的上气道自主呼吸的麻醉犬中，上气道肌肉收缩对气道通畅性的影响。测量气流和声门上压力以获得Ruaw。通过经皮植入咽黏膜下的橡胶气球进行吸气来调节Ruaw，以产生部分或完全阻塞。将线电极双侧植入颏舌肌（GG）、颏舌骨肌（GH）、胸骨甲状肌（ST）和胸骨舌骨肌（SH）进行电刺激（ES），并植入鼻翼进行肌电图（EMG）记录。在部分或完全上气道阻塞之前和期间，对每块肌肉施加三个水平的电刺激。颏舌肌和颏舌骨肌刺激均导致Ruaw显著降低，在部分阻塞期间最为明显，Ruaw分别从54±11降至14±3以及从74±12降至31±5 cmH₂O·L⁻¹·s。在低电压时，刺激颏舌肌在降低Ruaw方面比刺激颏舌骨肌更有效。此外，刺激颏舌肌而非颏舌骨肌可解除完全阻塞。相比之下，刺激胸骨舌骨肌和胸骨甲状肌对Ruaw无显著影响。这些发现表明，在自主呼吸的麻醉犬中，选择性上气道扩张肌收缩可在存在上气道阻塞时降低Ruaw并解除上气道阻塞，其中颏舌肌是最有效的肌肉。这有利于进一步尝试研究电刺激选定的上气道肌肉在治疗阻塞性睡眠呼吸暂停综合征中的益处。
