Local mechanisms drive genioglossus activation in obstructive sleep apnea

Atul Malhotra, Robert B. Fogel, Jill K. Edwards, Steven A. Shea, David P. White

Research output: Contribution to journalArticlepeer-review

86 Scopus citations


Individuals with obstructive sleep apnea (OSA) require increased pharyngeal muscle dilator activation during wakefulness to maintain upper airway patency. Negative pressure is one potential stimulus for this neuromuscular compensation. Individuals with OSA who have previously undergone tracheostomy provide an opportunity to study upper airway physiology in both the presence and absence of upper airway respiratory stimuli. If negative pressure (or another local airway stimulus) were important in driving pharyngeal dilator muscle activation, one would predict that during nasal breathing, the pharynx of a tracheostomized patient would be exposed to negative pressure, and that high levels of muscle activation would therefore be measured. Conversely, during breathing by the patient through the tracheal stoma, one would expect low levels of muscle activation in the absence of local stimuli. We measured a number of respiratory variables, including genioglossus activation under both nasal and tracheal stomal breathing conditions, in five patients. In all five patients there was a significant and substantial decrease in both peak phasic (100 ± 0 to 53.4 ± 9.2 arbitrary units [mean ± SEM], p < 0.01) and tonic genioglossus activation (36.3 ± 5.13 to 20.7 ± 3.9 arbitrary units, p < 0.05) during stomal breathing as compared with nasal breathing. We conclude that local upper airway respiratory stimuli, possibly negative pressure, are important in mediating the increased pharyngeal dilator muscle activation seen in sleep apnea patients during wakefulness.

Original languageEnglish (US)
Pages (from-to)1746-1749
Number of pages4
JournalAmerican journal of respiratory and critical care medicine
Issue number5
StatePublished - 2000
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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