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Original Research: SLEEP MEDICINE |

The Influence of Obstructive Sleep Apnea and Gender on Genioglossus Activity During Rapid Eye Movement Sleep

Danny J. Eckert, PhD; Atul Malhotra, MD, FCCP; Yu L. Lo, MD; David P. White, MD, FCCP; Amy S. Jordan, PhD
Author and Funding Information

*From the Brigham and Women's Hospital (Drs. Eckert, Malhotra, White, and Jordan), Division of Sleep Medicine, Sleep Disorders Program and Harvard Medical School, Boston, MA; and the Department of Thoracic Medicine (Dr. Lo), Chang Gang Memorial Hospital, Chang Gang University College of Medicine, Taipei, Taiwan.

Correspondence to: Danny J. Eckert, PhD, Brigham and Women's Hospital, Division of Sleep Medicine, Sleep Disorders Program, 221 Longwood Ave, Boston, MA 02115; e-mail: deckert@rics.bwh.harvard.edu


This study was supported by National Institutes of Health grants P50 HL60292, R01 HL085188-01, RO1-HL73146, AG024837-01, and RR01032; and by American Heart Association grants 0635318N and 0840159N. Dr. Eckert is supported by the Thoracic Society of Australia and New Zealand/Allen and Hanbury's Respiratory Research Fellowship.

Dr. Malhotra has received consulting and/or research income from Respironics, Restore/Medtronic, NMT Medical, Apnex Medical, Itamar Medical, Pfizer, Cephalon, and Inspiration Medical. Dr. White is Chief Medical Officer for Respironics Inc. Drs. Eckert, Lo, and Jordan have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(4):957-964. doi:10.1378/chest.08-2292
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Background:  The mechanisms contributing to worsening of obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep have been minimally studied. Reduced upper-airway muscle tone may be an important contributor. Because respiratory events and the associated blood gas changes can influence genioglossus (GG) activity, we compared GG activity between OSA patients and control subjects during REM sleep using continuous positive airway pressure (CPAP) to minimize the influences of upper-airway resistance (RUA) and blood gas disturbances on GG activity.

Methods:  Twenty subjects (10 female subjects), 12 healthy individuals, and 8 OSA patients, were studied overnight. Sleep staging, epiglottic pressure, minute ventilation, and GG electromyogram (GGEMG) were recorded. GGEMG was compared between REM sleep with (phasic REM) and without (tonic REM) eye movements, non-REM (NREM) sleep, and wakefulness.

Results:  Breathing frequency increased from stable NREM, to tonic REM to phasic REM sleep, whereas tidal volume and GGEMG decreased (ie, peak GGEMG: 3.0 ± 0.7 vs 1.7 ± 0.4 vs 1.2 ± 0.3% max, respectively; p < 0.001). Reductions in GGEMG during REM sleep were not different between OSA patients and control subjects or between genders.

Conclusions:  When RUA and blood gas disturbances are minimized by CPAP, genioglossal activity is reduced in a stepwise manner from stable NREM, to tonic REM to phasic REM sleep to a similar extent in OSA and healthy individuals of both genders. Thus, an inherent abnormality in GG neural control in OSA patients during REM sleep is unlikely to explain the increased upper-airway collapse in this sleep stage. Rather, a generalized reduction in GG activity during REM likely renders individuals who are highly reliant on upper-airway dilator muscles vulnerable to pharyngeal collapse during REM sleep.

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