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Schwab RJ, Lin TC, Wiemken A, Dedhia RC, Wehrli FW, Keenan BT. State-Dependent Biomechanical Behavior of Oropharyngeal Structures in Apneic and Control Subjects: A Proof-of-Concept Study. Ann Am Thorac Soc 2024; 21:949-960. [PMID: 38507612 PMCID: PMC11160136 DOI: 10.1513/annalsats.202309-847oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/20/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale: Apneic individuals have reduced airway caliber during sleep. The biomechanical changes in upper airway anatomy contributing to this airway narrowing are largely unknown. Objectives: We sought to investigate the state-dependent (wake vs. sleep) biomechanical behavior of the upper airway soft-tissue and craniofacial structures. Methods: Upper airway magnetic resonance imaging was performed in 15 sleep-deprived control subjects (apnea-hypopnea index, <5; 0.3 ± 0.5 events per hour) and 12 sleep-deprived apneic subjects (apnea-hypopnea index, ⩾5; 35.2 ± 18.1 events per hour) during wake and sleep and analyzed for airway measures and soft-tissue/mandibular movement. Results: In the retropalatal region, control subjects showed sleep-dependent reductions (P ⩽ 0.037) in average cross-sectional airway area (CSA), minimum CSA, and anteroposterior and lateral dimensions. Apneic subjects showed sleep-dependent reductions (P ⩽ 0.002) in average CSA, minimum CSA, and anteroposterior and lateral dimensions. In the retroglossal region, control subjects had no sleep-dependent airway reductions. However, apneic subjects had sleep-dependent reductions in minimal CSA (P = 0.001) and lateral dimensions (P = 0.014). Control subjects only showed sleep-dependent posterior movement of the anterior-inferior tongue octant (P = 0.039), whereas apneic subjects showed posterior movement of the soft palate (P = 0.006) and all tongue octants (P ⩽ 0.012). Sleep-dependent medial movement of the lateral walls was seen at the retropalatal minimum level (P = 0.013) in control subjects and at the retropalatal and retroglossal minimum levels (P ⩽ 0.017) in apneic subjects. There was posterior movement of the mandible in apneic subjects (P ⩽ 0.017). Conclusions: During sleep, control and apneic subjects showed reductions in retropalatal airway caliber, but only the apneic subjects showed retroglossal airway narrowing. Reductions in anteroposterior and lateral airway dimensions were primarily due to posterior soft palate, tongue and mandibular movement and to medial lateral wall movement. These data provide important initial insights into obstructive sleep apnea pathogenesis.
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Affiliation(s)
| | - Theodore C. Lin
- Division of Sleep Medicine, Department of Medicine
- Department of Otorhinolaryngology – Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania
| | | | - Raj C. Dedhia
- Division of Sleep Medicine, Department of Medicine
- Department of Otorhinolaryngology – Head and Neck Surgery, and
| | - Felix W. Wehrli
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; and
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2
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Gou D, Zhu Q, Chan HK, Kourmatzis A, Cheng S, Yang R. Effects of the deformation and size of the upper airway on the deposition of aerosols. Int J Pharm 2024; 657:124165. [PMID: 38663643 DOI: 10.1016/j.ijpharm.2024.124165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
Aerosol drug delivery in the human airway is significantly affected by the morphology and size of the airway. This work developed a CFD-DEM model to simulate and analyze air flow and powder dynamics in combined inhaler-airway systems with different degrees of airway deformation (non-deformed, 50%, and 75% deformed) and sizes (adult, 0.80, and 0.62 scaled). The airways were generated based on a regular airway constructed from the MRI images through finite element method (for deformed airways) or scaling-down (for smaller airways). The airways were connected to Turbuhaler® through a connector. The results showed that under the same flow rate, the variation in the airway geometry and size had a minimum impact on the flow field and powder deposition in the device and the connector. However, deformation caused more particle deposition in the deformed region. Notably, the airway with 50% deformation had the most particles passing through the airway with the largest particle sizes due to its lower air velocity in the deformed area. Reducing airway size resulted in more powder deposition on the airway, particularly at the pharynx and mouth regions. This was because, with the same flow rate, the flow velocity in the smaller airway was higher, causing more particle-wall collisions in the mouth and pharynx regions. More importantly, the deposition efficiency in the 0.62-scaled airway was significantly higher than the other two airways, highlighting the importance of the different administration of aerosol drugs for young children.
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Affiliation(s)
- Dazhao Gou
- School of Materials Science and Engineering, UNSW Sydney, NSW 2052, Australia
| | - Qixuan Zhu
- School of Materials Science and Engineering, UNSW Sydney, NSW 2052, Australia
| | - Hak-Kim Chan
- Advanced Drug Delivery Group, Sydney Pharmacy School, The University of Sydney, NSW 2006, Australia
| | - Agisilaos Kourmatzis
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, NSW 2006, Australia
| | - Shaokoon Cheng
- School of Engineering, Macquarie University, NSW 2109, Australia
| | - Runyu Yang
- School of Materials Science and Engineering, UNSW Sydney, NSW 2052, Australia.
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3
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Jugé L, Liao A, Yeung J, Knapman FL, Bull C, Burke PG, Brown EC, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Regional associations between inspiratory tongue dilatory movement and genioglossus activity during wakefulness in people with obstructive sleep apnoea. J Physiol 2023; 601:5795-5811. [PMID: 37983193 PMCID: PMC10953361 DOI: 10.1113/jp285187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
Inspiratory tongue dilatory movement is believed to be mediated via changes in neural drive to genioglossus. However, this has not been studied during quiet breathing in humans. Therefore, this study investigated this relationship and its potential role in obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue dilatory movement, quantified with tagged magnetic resonance imaging, and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in nine controls [apnoea-hypopnea index (AHI) ≤5 events/h] and 37 people with untreated OSA (AHI >5 events/h). Measurements were obtained for 156 neuromuscular compartments (85%). Analysis was adjusted for nadir epiglottic pressure during inspiration. Only for 106 compartments (68%) was a larger anterior (dilatory) movement associated with a higher phasic EMG [mixed linear regression, beta = 0.089, 95% CI [0.000, 0.178], t(99) = 1.995, P = 0.049, hereafter EMG↗/mvt↗]. For the remaining 50 (32%) compartments, a larger dilatory movement was associated with a lower phasic EMG [mixed linear regression, beta = -0.123, 95% CI [-0.224, -0.022], t(43) = -2.458, P = 0.018, hereafter EMG↘/mvt↗]. OSA participants had a higher odds of having at least one decoupled EMG↘/mvt↗ compartment (binary logistic regression, odds ratio [95% CI]: 7.53 [1.19, 47.47] (P = 0.032). Dilatory tongue movement was minimal (>1 mm) in nearly all participants with only EMG↗/mvt↗ compartments (86%, 18/21). These results demonstrate that upper airway dilatory mechanics cannot be predicted from genioglossus EMG, particularly in people with OSA. Tongue movement associated with minimal genioglossus activity suggests co-activation of other airway dilator muscles. KEY POINTS: Inspiratory tongue movement is thought to be mediated through changes in genioglossus activity. However, it is unknown if this relationship is altered by obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue movement, quantified with tagged magnetic resonance imaging (MRI), and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in four tongue compartments of people with and without OSA. Larger tongue anterior (dilatory) movement was associated with higher phasic genioglossus EMG for 68% of compartments. OSA participants had an ∼7-times higher odds of having at least one compartment for which a larger anterior tongue movement was not associated with a higher phasic EMG than controls. Therefore, higher genioglossus phasic EMG does not consistently translate into tongue dilatory movement, particularly in people with OSA. Large dilatory tongue movements can occur despite minimal genioglossus inspiratory activity, suggesting co-activation of other pharyngeal muscles.
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Affiliation(s)
- Lauriane Jugé
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Angela Liao
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jade Yeung
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Fiona L. Knapman
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Christopher Bull
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Peter G.R. Burke
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Macquarie Medical SchoolFaculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Elizabeth C. Brown
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Simon C. Gandevia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Danny J. Eckert
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research InstituteFlinders UniversityAdelaideAustralia
| | - Jane E. Butler
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lynne E. Bilston
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
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Martin-Harris B, Kantarcigil C, Reedy EL, McFarland DH. Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions. Dysphagia 2023; 38:1049-1058. [PMID: 36378345 PMCID: PMC10266896 DOI: 10.1007/s00455-022-10538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
Swallowing occurs preferentially in the expiratory phase of the quiet breathing cycle and at mid-to-low tidal volume. This coordinative pattern imparts important biomechanical advantages to swallowing and airway protection and facilitate laryngeal elevation, laryngeal vestibular and vocal fold closure, and cricopharyngeal sphincter opening. This preferred coordinative relationship between breathing and swallowing is impaired in a variety of patient populations, including head and neck cancer survivors with dysphagia. We developed a training protocol to re-establish more optimal phasing of swallowing with breathing in these patients with striking outcomes, including reduced swallowing physiological impairments and improved airway protection. This motivated us to continue to refine and expand this training protocol and develop new assistive technologies for swallowing monitoring outside of the lab. In this review, we highlight the origins of our optimal respiratory-swallowing coordination hypothesis, describe the biomechanical advantages it provides, carefully describe our training protocol and findings, and chart a course for the next phase of this work. Our overall goal is to harness technology combined with carefully constructed learning paradigms to improve the lives of patients with impaired respiratory-swallowing coordination consequent to a variety of pathologies including head and neck cancer and degenerative neurological conditions such as Parkinson's disease.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
- Otolaryngology - Head & Neck Surgery, Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA.
| | - Cagla Kantarcigil
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
| | - Erin L Reedy
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA
| | - David H McFarland
- Faculties of Medicine, Université de Montréal and McGill University, Montreal, CA, USA
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, CA, USA
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5
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Attali V, Weber M, Rivals I, Similowski T, Arnulf I, Gatignol P. Moderate-to-severe obstructive sleep apnea syndrome is associated with altered tongue motion during wakefulness. Eur Arch Otorhinolaryngol 2023; 280:2551-2560. [PMID: 36707431 DOI: 10.1007/s00405-023-07854-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Impairment of genioglossus control is a frequent "non-anatomical" cause of obstructive sleep apnea syndrome (OSAS) in non- or mildly obese patients. Although wake-related compensatory mechanisms prevent the occurrence of obstructive events, the genioglossus control is often impaired during wakefulness. We hypothesized that the lingual motion would be altered during wakefulness in this population in patients with moderate-to-severe OSAS. METHODS We included non- or mildly obese participants with suspected OSAS. They underwent a Bucco-Linguo-Facial Motor Skills assessment using the MBLF ("Motricité Bucco-Linguo-Faciale"), which includes an evaluation of 13 movements of the tongue. This was followed by a night-attended polysomnography. We compared patients with moderate-to-severe OSAS (apnea-hypopnea index (AHI) ≥ 15/h; n = 15) to patients without or with mild OSAS (AHI < 15/h; n = 24). RESULTS MBLF total and "tongue" sub-scores were lower in patients with moderate-to-severe OSAS: total z-score - 0.78 [- 1.31; 0.103] versus 0.20 [- 0.26; 0.31], p = 0.0011; "tongue" z-sub-score (- 0.63 [- 1.83; 0.41] versus 0.35 [0.26; 0.48], p = 0.014). There was a significant age-adjusted correlation between the "tongue" sub-score and AHI. The logistic regression model for the prediction of moderate-to-severe OSAS gave area under the curve ratio of 88.2% for MBLF score plus age. CONCLUSIONS Myofunctional activity of the tongue is impaired during wakefulness in non- or mildly obese patients with moderate-to-severe OSAS. This study supports the lingual myofunctional assessment using the MBLF in screening of moderate-to-severe OSAS. This simple tool could help clinicians to select patients with suspected moderate-to-severe OSAS for polysomnography.
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Affiliation(s)
- Valérie Attali
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France. .,Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| | - Mathilde Weber
- Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département R3S, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Isabelle Arnulf
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institut du Cerveau, Paris Brain Institute-ICM, INSERM, CNRS, Sorbonne Université, 75013, Paris, France
| | - Peggy Gatignol
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France.,Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
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6
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A review of upper airway physiology relevant to the delivery and deposition of inhalation aerosols. Adv Drug Deliv Rev 2022; 191:114530. [PMID: 36152685 DOI: 10.1016/j.addr.2022.114530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/07/2022] [Accepted: 09/01/2022] [Indexed: 01/24/2023]
Abstract
Developing effective oral inhaled drug delivery treatment strategies for respiratory diseases necessitates a thorough knowledge of the respiratory system physiology, such as the differences in the airway channel's structure and geometry in health and diseases, their surface properties, and mechanisms that maintain their patency. While respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma and their implications on the lower airways have been the core focus of most of the current research, the role of the upper airway in these diseases is less known, especially in the context of inhaled drug delivery. This is despite the fact that the upper airway is the passageway for inhaled drugs to be delivered to the lower airways, and their replicas are indispensable in current standards, such as the cascade impactor experiments for testing inhaled drug delivery technology. This review provides an overview of upper airway collapsibility and their mechanical properties, the effects of age and gender on upper airway geometry, and surface properties. The review also discusses how COPD and asthma affect the upper airway and the typical inhalation flow characteristics exhibited by the patients with these diseases.
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7
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Ma Z, Kourmatzis A, Milton-McGurk L, Chan HK, Farina D, Cheng S. Simulating the effect of individual upper airway anatomical features on drug deposition. Int J Pharm 2022; 628:122219. [PMID: 36179925 DOI: 10.1016/j.ijpharm.2022.122219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 10/31/2022]
Abstract
This study aims to systematically isolate different anatomical features of the human pharynx with the goal to investigate their independent influence on airflow dynamics and particle deposition characteristics in a geometrically realistic human airway. Specifically, the effects of the uvula, epiglottis and soft palate on drug particle deposition are studied systematically, by carefully removing each of these anatomical features from reconstructed models based on MRI data and comparing them to a benchmark realistic airway model. Computational Fluid Dynamics using established turbulence models is employed to simulate the transport of mono-dispersed particles (3 µm) in the airway at two flow-rates. The simulations suggest three findings: 1) widening the space between the oral cavity and oropharynx and where the soft palate is situated leads to the most dramatic reduction in drug deposition in the upper airway; 2) exclusion of the uvula and epiglottis: a) affects flow dynamics in the airway; b) alters regional deposition behaviour; c) does not significantly affect the total number of particles deposited in the pharynx; and 3) the space adjacent to the soft palate is a key determinant for aerosol deposition in the extrathoracic region and is related to mechanisms of flow acceleration, diversion and recirculation.
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Affiliation(s)
- Zhaoqi Ma
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, NSW 2006
| | - Agisilaos Kourmatzis
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, NSW 2006
| | - Liam Milton-McGurk
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, NSW 2006
| | - Hak-Kim Chan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006
| | - Dino Farina
- Proveris Scientific Corporation, Hudson, Massachusetts, United States
| | - Shaokoon Cheng
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109.
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8
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Bordoni B, Escher AR, Toccafondi A, Mapelli L, Banfi P. Obstructive Sleep Apnea and Role of the Diaphragm. Cureus 2022; 14:e29004. [PMID: 36159353 PMCID: PMC9495286 DOI: 10.7759/cureus.29004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 11/07/2022] Open
Abstract
Obstructive sleep apnea (OSA) causes multiple local and systemic pathophysiological consequences, which lead to an increase in morbidity and mortality in patients suffering from this disorder. OSA presents with various nocturnal events of apnoeas or hypopneas and with sub-clinical airflow limitations during wakefulness. OSA involves a large percentage of the population, particularly men, but the estimate of OSA patients could be much broader than data from the literature. Most of the research carried out in the muscle field is to understand the causes of the presence of chronic nocturnal desaturation and focus on the genioglossus muscle and other muscles related to dilating the upper airways. Sparse research has been published regarding the diaphragm muscle, which is the main muscle structure to insufflate air into the airways. The article reviews the functional anatomy of the muscles used to open the upper respiratory tract and the non-physiological adaptation that follows in the presence of OSA, as well as the functional anatomy and pathological adaptive aspects of the diaphragm muscle. The intent of the text is to highlight the disparity of clinical interest between the dilator muscles and the diaphragm, trying to stimulate a broader approach to patient evaluation.
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Hatt A, Brown E, Berlowitz DJ, O’Donoghue F, Meaklim H, Connelly A, Jackson G, Sutherland K, Cistulli PA, Lee BSB, Bilston LE. Tetraplegic obstructive sleep apnoea patients dilate the airway similarly to able-bodied obstructive sleep apnoea patients. J Spinal Cord Med 2022; 45:536-546. [PMID: 33166204 PMCID: PMC9246266 DOI: 10.1080/10790268.2020.1829418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context/objective: Obstructive sleep apnoea (OSA) develops soon after cervical spinal cord injury (SCI) at rates higher than the general population, but the mechanisms are not understood. This study aimed to determine whether OSA in SCI is associated with altered pharyngeal muscle dilatory mechanics during quiet breathing, as has been observed in the non-SCI injured with obstructive sleep apnoea.Design: Cross sectional imaging study.Setting: Medical research institute.Participants: Eight cervical SCI patients with OSA were recruited and compared to 13 able-bodied OSA patients and 12 able-bodied healthy controls of similar age and BMI.Interventions and outcome measures: 3T MRI scans of upper airway anatomy and tagged-MRI to characterize airway muscle motion during quiet breathing were collected for analysis.Results: Considerable variation in the patterns of inspiratory airway muscle motion was observed in the SCI group, with some participants exhibiting large inspiratory airway dilatory motions, and others exhibiting counterproductive narrowing during inspiration. These patterns were not dissimilar to those observed in the able-bodied OSA participants. The increase in airway cross-sectional area of able-bodied control participants was proportional to increase in BMI, and a similar, but not significant, relationship was present in all groups.Conclusion: Despite the limited sample size, these data suggest that SCI OSA patients have heterogeneous pharyngeal dilator muscle responses to the negative pressures occurring during inspiration but, as a group, appear to be more similar to able-bodied OSA patients than healthy controls of similar age and BMI. This may reflect altered pharyngeal pressure reflex responses in at least some people with SCI.
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Affiliation(s)
- Alice Hatt
- Neuroscience Research Australia, Randwick, Australia
| | - Elizabeth Brown
- Neuroscience Research Australia, Randwick, Australia,Prince of Wales Hospital, Randwick, Australia
| | - David J. Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia,Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Fergal O’Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia,Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia,The Florey Institute of Neuroscience and Menta l Health, Melbourne Brain Centre, Heidelberg, Australia
| | - Hailey Meaklim
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Alan Connelly
- The Florey Institute of Neuroscience and Menta l Health, Melbourne Brain Centre, Heidelberg, Australia
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Menta l Health, Melbourne Brain Centre, Heidelberg, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St. Leonards, Australia,Charles Perkins Centre, University of Sydney, St. Leonards, Australia
| | - Peter A. Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St. Leonards, Australia,Charles Perkins Centre, University of Sydney, St. Leonards, Australia
| | - Bon San Bonne Lee
- Neuroscience Research Australia, Randwick, Australia,Prince of Wales Hospital, Randwick, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia, Randwick, Australia,University of New South Wales, Randwick, Australia,Correspondence to: Lynne Bilston, Neuroscience Research Australia, 139 Barker St, Randwick, NSW2031, Australia; 61293991673, 61293991027.
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10
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Carberry JC, Burke PGR, Osman AM, Jugé L, Toson B, Gandevia SC, Butler JE, Bilston LE, Eckert DJ. Regional genioglossus reflex responses to negative pressure pulses in people with obstructive sleep apnea. J Appl Physiol (1985) 2022; 133:755-765. [PMID: 35771222 DOI: 10.1152/japplphysiol.00083.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tongue and upper airway dilator muscle movement patterns during quiet breathing vary in people with obstructive sleep apnea (OSA). Many patients have inadequate or counterproductive responses to inspiratory negative airway pressure that likely contributes to their OSA. This may be due, at least in part, to inadequate or non-homogeneous reflex drive to different regions of the largest upper airway dilator, genioglossus. To investigate potential regional heterogeneity of genioglossus reflex responses in OSA, brief suction pulses were applied via nasal breathing mask and electromyogram (EMG) was recorded in 4 regions (anterior oblique, anterior horizontal, posterior oblique, posterior horizontal) using intramuscular fine wire electrodes in 15 people with OSA. Genioglossus short-latency reflex excitation amplitude had regional heterogeneity (horizontal vs. oblique regions) when expressed in absolute units but homogeneity when normalized as a percentage of the immediate (100ms) pre-stimulus EMG. Regional variability in reflex morphology (excitation and inhibition) was present in one third of participants. Minimum cross-sectional area (CSA) of the pharyngeal airway quantified using MRI and may be related to the amplitude of the short-latency reflex response to negative pressure such that we found that people with a smaller CSA tended to have greater reflex amplitude (e.g. horizontal region r2=0.41, p=0.01). These findings highlight the complexity of genioglossus reflex control, the potential for regional heterogeneity and the functional importance of upper airway anatomy in mediating genioglossus reflex responses to rapid changes in negative pressure in OSA.
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Affiliation(s)
- Jayne C Carberry
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia.,University College Dublin, School of Medicine, Ireland
| | - Peter George Redmayne Burke
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia.,Department of Biomedical Sciences, Macquarie University, Australia
| | - Amal M Osman
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Barbara Toson
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
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11
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Alvarado C, Arminjon A, Damieux-Verdeaux C, Lhotte C, Condemine C, Cousin AS, Sigaux N, Bouletreau P, Mateo S. Impaired tongue motor control after temporomandibular disorder: A proof-of-concept case-control study of tongue print. Clin Exp Dent Res 2022; 8:529-536. [PMID: 35220688 PMCID: PMC9033548 DOI: 10.1002/cre2.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Temporomandibular disorder (TMD) perturbs the tongue motor control and consequently impairs oral function, but strength training reduces this impairment. However, tongue motor control is widely reduced to a matter of strength. OBJECTIVES To investigate the accuracy of the tongue placement as a measure of tongue motor control in patients with TMD compared with age- and sex-matched healthy participants. MATERIAL AND METHODS This proof-of-concept case-control study was prospective, observational, and part of the TMIQ study (NCT04102306). After pointing against a wood stick while maintaining the tongue as sharp as possible, the examinator drew the contour of the tongue print on the wood stick, which was then scanned for image analyses to compute the area for each participant using ImageJ. RESULTS A total of 94 participants were included, all patients with TMD (n = 47) diagnosed with myalgia, 61% with intra-articular joint disorder accordingly to the DC/TMD. The median (IQR) tongue print area was 117 (111) mm2 for the TMD group and 93.5 (76.2) mm2 for the control group (V = 352, p = .04) and the median [95% confidence interval] difference was 25.4 [1.3; 51.0] mm². Overlapping of the 95% confidence intervals of the area evidenced no significant difference between the categories of the DC/TMD. The corrected each area-total correlation (r = .24) suggests a reasonably homogenous thus valid measure. CONCLUSION The results suggest that TMD impairs the motor control of the tongue. Therefore, the sharpest tongue pointing test may constitute a simple and accessible clinical tool to assess the accuracy of tongue placement in TMD patients. The study was registered on ClinicalTrial.gov with identification number NCT04102306.
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Affiliation(s)
| | | | | | - Claire Lhotte
- Cabinet de kinésithérapie Saint-Alexandre, Lyon, France
| | - Chloé Condemine
- Cabinet de kinésithérapie Saint-Alexandre, Lyon, France.,Hospices Civils de Lyon, Groupement Hospitalier sud, Chirurgie maxillo-faciale, Pierre-Bénite, Cedex, France
| | - Anne-Sabine Cousin
- Hospices Civils de Lyon, Groupement Hospitalier sud, Chirurgie maxillo-faciale, Pierre-Bénite, Cedex, France
| | - Nicolas Sigaux
- Hospices Civils de Lyon, Groupement Hospitalier sud, Chirurgie maxillo-faciale, Pierre-Bénite, Cedex, France
| | - Pierre Bouletreau
- Hospices Civils de Lyon, Groupement Hospitalier sud, Chirurgie maxillo-faciale, Pierre-Bénite, Cedex, France
| | - Sébastien Mateo
- Lyon Neuroscience Research Center, Trajectoires Team, CNRS UMR5292, INSERM U1028, Université de Lyon, Université Lyon 1, Lyon, France.,Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon, France
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12
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Effects of respiratory rate on the fluid mechanics of a reconstructed upper airway. Med Eng Phys 2022; 100:103746. [DOI: 10.1016/j.medengphy.2021.103746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 11/25/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022]
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13
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Yeung J, Burke PGR, Knapman FL, Patti J, Brown EC, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Task-dependent neural control of regions within human genioglossus. J Appl Physiol (1985) 2022; 132:527-540. [PMID: 34989652 DOI: 10.1152/japplphysiol.00478.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Anatomical and imaging evidence suggests neural control of oblique and horizontal compartments of the genioglossus differs. However, neurophysiological evidence for differential control remains elusive. This study aimed to determine whether there are differences in neural drive to the oblique and horizontal regions of the genioglossus during swallowing and tongue protrusion. Adult participants (N=63; 48M) were recruited from a sleep clinic; 41 had Obstructive Sleep Apnoea (OSA: 34M, 8F). Electromyographic (EMG) was recorded at rest (awake, supine) using 4 intramuscular fine-wire electrodes inserted percutaneously into the anterior oblique, posterior oblique, anterior horizontal and posterior horizontal genioglossus. Epiglottic pressure and nasal airflow were also measured. During swallowing, two distinct EMG patterns were observed- a monophasic response (single EMG peak) and a biphasic response (two bursts of EMG). Peak EMG and timing of the peak relative to epiglottic pressure were significantly different between patterns (linear mixed models, p<0.001). Monophasic activation was more likely in the horizontal than oblique region during swallowing (OR=6.83, CI=3.46-13.53, p<0.001). In contrast, during tongue protrusion, activation patterns and EMG magnitude were not different between regions. There were no systematic differences in EMG patterns during swallowing or tongue protrusion between OSA and non-OSA groups. These findings provide evidence for functional differences in the motoneuronal output to the oblique and horizontal compartments, enabling differential task-specific drive. Given this, it is important to identify the compartment from which EMG is acquired. We propose that the EMG patterns during swallowing may be used to identify the compartment where a recording electrode is located.
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Affiliation(s)
- Jade Yeung
- grid.250407.4Neuroscience Research Australia, Sydney, New South Wales, Australia
| | | | - Fiona L Knapman
- grid.250407.4Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jessica Patti
- grid.250407.4Neuroscience Research Australia, Randwick, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Simon C Gandevia
- grid.250407.4Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health (AISH)/ Flinders Health and Medical Research Institute Sleep Health, grid.1014.4Flinders University, Bedford Park, SA, Australia
| | - Jane E Butler
- grid.250407.4Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, grid.1005.4Neuroscience Research Australia, Randwick, Australia
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14
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Scott AM, Reed WM. Panoramic radiography and patients with disability: a new simple breathing technique to reduce common airspace error. J Med Radiat Sci 2022; 69:261-266. [PMID: 34984850 PMCID: PMC9163455 DOI: 10.1002/jmrs.564] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/04/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022] Open
Abstract
Patients with intellectual disabilities often fail to follow traditional tongue position instructions for panoramic radiographs resulting in missed pathology or unnecessary further radiation. This simple breathing technique is a new clinical instruction method for panoramic radiography developed to reduce the most common patient position error: patient failure to hold the tongue to the roof of the mouth. The technique is suitable for all patients including young patients and those with intellectual disabilities. The simple breathing technique uses 'tell-show-do' communication methods and does not mention the tongue but utilises the known tongue positions that occur during breathing and swallowing. This simple breathing technique instruction for panoramic radiography uses a demonstration of 'breathe-in, breathe-out, swallow, lips closed and hold still' to reduce the intensity of both the palatoglossal and pharyngeal airspaces on panoramic radiographs. This method, referred in this article as the simple breathing technique, can improve the diagnostic potential of panoramic radiographs and can be used with young children and patients with intellectual disabilities, and this slow breathing technique can help them further relax.
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Affiliation(s)
- Antonia M Scott
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Warren M Reed
- Medical Image Perception and Optimisation Group (MIOPeG), Discipline of Medical Imaging Science, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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15
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Mayerl CJ, Steer KE, Chava AM, Bond LE, Edmonds CE, Gould FDH, Hieronymous TL, Vinyard CJ, German RZ. Anatomical and physiological variation of the hyoid musculature during swallowing in infant pigs. J Exp Biol 2021; 224:jeb243075. [PMID: 34734633 PMCID: PMC10659033 DOI: 10.1242/jeb.243075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
The function of a muscle is impacted by its line of action, activity timing and contractile characteristics when active, all of which have the potential to vary within a behavior. One function of the hyoid musculature is to move the hyoid bone during swallowing, yet we have little insight into how their lines of action and contractile characteristics might change during a swallow. We used an infant pig model to quantify the contractile characteristics of four hyoid muscles during a swallow using synchronized electromyography, fluoromicrometry and high-speed biplanar videofluoroscopy. We also estimated muscle line of action during a swallow using contrast-enhanced CT-scanned muscles animated to move with the hyoid bone and found that as the hyoid elevated, the line of action of the muscles attached to it became greater in depression. We also found that muscles acted eccentrically and concentrically, which was correlated with hyoid movement. This work contributes to our understanding of how the musculature powering feeding functions during swallowing.
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Affiliation(s)
- Christopher J. Mayerl
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Kendall E. Steer
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Almasi M. Chava
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Laura E. Bond
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Chloe E. Edmonds
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Francois D. H. Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ 08084, USA
| | - Tobin L. Hieronymous
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Christopher J. Vinyard
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Rebecca Z. German
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
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16
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Luu BL, Walsh LD, Hübner PP, Eckert DJ, Bilston LE, Gandevia SC, Butler JE. Tongue acceleration in humans evoked with intramuscular electrical stimulation of genioglossus. Respir Physiol Neurobiol 2021; 295:103786. [PMID: 34508867 DOI: 10.1016/j.resp.2021.103786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/23/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023]
Abstract
Genioglossus was stimulated intramuscularly to determine the effect of regional activation of the muscle on tongue movement in eight healthy adults. Stimulation at motor threshold was delivered with a needle electrode inserted to different depths in the anterior and posterior regions of genioglossus. The current amplitude that induced muscle contraction was ∼80% higher for anterior than posterior sites. Evoked tongue movements were determined from stimulus-triggered averages (150 pulses) of the outputs from an accelerometer fixed to the posterosuperior surface of the tongue. The median amplitude [95% confidence intervals] for the resultant acceleration was 0.0 m/s2 [0.0, 0.2] for anterior and 0.6 m/s2 [0.1, 2.8] for posterior sites. There was a positive relationship between acceleration amplitude and stimulation depth in the posterior of genioglossus (p < 0.001), but acceleration amplitude did not vary with stimulation depth in the anterior region (p = 0.83). This heterogeneity in acceleration responses between muscle regions may contribute to differences in collapsibility of the upper airway.
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Affiliation(s)
- Billy L Luu
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Lee D Walsh
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Platypus Technical Consultants Pty Ltd, Canberra, Australia
| | - Patrick P Hübner
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
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17
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Jugé L, Olsza I, Knapman FL, Burke PGR, Brown EC, Stumbles E, Bosquillon de Frescheville AF, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Effect of upper airway fat on tongue dilation during inspiration in awake people with obstructive sleep apnea. Sleep 2021; 44:6330603. [PMID: 34323992 DOI: 10.1093/sleep/zsab192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/19/2021] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES To investigate the effect of upper airway fat composition on tongue inspiratory movement and obstructive sleep apnea (OSA). METHODS Participants without or with untreated OSA underwent a 3T magnetic resonance imaging (MRI) scan. Anatomical measurements were obtained from T2-weighted images. Mid-sagittal inspiratory tongue movements were imaged using tagged MRI during wakefulness. Tissue volumes and percentages of fat were quantified using an mDIXON scan. RESULTS 40 predominantly overweight participants with OSA were compared to 10 predominantly normal weight controls. After adjusting for age, BMI and gender, the percentage of fat in the tongue was not different between groups (ANCOVA, P=0.45), but apnoeic patients had a greater tongue volume (ANCOVA, P=0.025). After adjusting for age, BMI and gender, higher OSA severity was associated with larger whole tongue volume (r=0.51, P<0.001), and greater dilatory motion of the anterior horizontal tongue compartment (r=-0.33, P=0.023), but not with upper airway fat percentage. Higher tongue fat percentage was associated with higher BMI and older age (Spearman r=0.43, P=0.002, and r=0.44, P=0.001, respectively), but not with inspiratory tongue movements. Greater inspiratory tongue movement was associated with larger tongue volume (e.g. horizontal posterior compartment, r=-0.44, P=0.002) and smaller nasopharyngeal airway (e.g. oblique compartment, r=0.29, P=0.040). CONCLUSIONS Larger tongue volume and a smaller nasopharynx are associated with increased inspiratory tongue dilation during wakefulness in people with and without OSA. This compensatory response was not influenced by higher tongue fat content. Whether this is also true in more obese patient populations requires further investigation.
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Affiliation(s)
- Lauriane Jugé
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Ida Olsza
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Fiona L Knapman
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Peter G R Burke
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Emma Stumbles
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Flinders Health and Medical Research Institute (FHMRI) and FHMRI Sleep Health/Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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18
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Fogarty MJ, Sieck GC. Tongue muscle contractile, fatigue, and fiber type properties in rats. J Appl Physiol (1985) 2021; 131:1043-1055. [PMID: 34323593 DOI: 10.1152/japplphysiol.00329.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The intrinsic and extrinsic tongue muscles manipulate the position and shape of the tongue and are activated during many oral and respiratory behaviors. In the present study, in 6-mo-old Fischer 344 rats, we examined mechanical and fatigue properties of tongue muscles in relation to their fiber type composition. In an ex vivo preparation, isometric force and fatigue was assessed by direct muscle stimulation. Tongue muscles were frozen in melting isopentane and transverse sections cut at 10 µm. In hematoxylin-eosin (H&E)-stained muscle sections, the relative fractions of muscle versus extracellular matrix were determined. Muscle fibers were classified as type I, IIa and IIx, and/or IIb based on immunoreactivity to specific myosin heavy chain isoform antibodies. Cross-sectional areas (CSAs) and proportions of different fiber types were used to calculate their relative contribution to total muscle CSAs. We found that the superior and inferior longitudinal intrinsic muscles (4.4 N/cm2) and genioglossus muscle (3.0 N/cm2) generated the greatest maximum isometric force compared with the transversalis muscle (0.9 N/cm2). The longitudinal muscles and the transversalis muscle displayed greater fatigue during repetitive stimulation consistent with the greater relative contribution of type IIx and/or IIb fibers. By contrast, the genioglossus, comprising a higher proportion of type I and IIa fibers, was more fatigue resistant. This study advances our understanding of the force, fatigue, and fiber type-specific properties of individual tongue musculature. The assessments and approach provide a readily accessible muscular readout for scenarios where motor control dysfunction or tongue weakness is evident.NEW & NOTEWORTHY For the individual tongue muscles, relatively little quantification of uniaxial force, fatigue, and fiber type-specific properties has been documented. Here, we assessed uniaxial-specific force generation, fatigability, and muscle fiber type-specific properties in the superior and inferior longitudinal muscles, the transversalis, and the genioglossus in Fischer 344 rats. The longitudinal muscles produced the greatest isometric tetanic-specific forces. The genioglossus was more fatigue resistant and comprised higher proportions of I and IIa fibers.
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Affiliation(s)
- Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, grid.66875.3aMayo Clinic, Rochester, Minnesota
| | - Gary C Sieck
- Department of Physiology and Biomedical Engineering, grid.66875.3aMayo Clinic, Rochester, Minnesota
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19
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Jugé L, Yeung J, Knapman FL, Burke PGR, Lowth AB, Gan KZC, Brown EC, Butler JE, Eckert DJ, Ngiam J, Sutherland K, Cistulli PA, Bilston LE. Influence of mandibular advancement on tongue dilatory movement during wakefulness and how this is related to oral appliance therapy outcome for obstructive sleep apnea. Sleep 2021; 44:5909314. [PMID: 32954420 DOI: 10.1093/sleep/zsaa196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/19/2020] [Indexed: 01/17/2023] Open
Abstract
STUDY OBJECTIVES To characterize how mandibular advancement splint (MAS) alters inspiratory tongue movement in people with obstructive sleep apnea (OSA) during wakefulness and whether this is associated with MAS treatment outcome. METHODS A total of 87 untreated OSA participants (20 women, apnea-hypopnea index (AHI) 7-102 events/h, aged 19-76 years) underwent a 3T MRI with a MAS in situ. Mid-sagittal tagged images quantified inspiratory tongue movement with the mandible in a neutral position and advanced to 70% of the maximum. Movement was quantified with harmonic phase methods. Treatment outcome was determined after at least 9 weeks of therapy. RESULTS A total of 72 participants completed the study: 34 were responders (AHI < 5 or AHI ≤ 10events/h with >50% reduction in AHI), 9 were partial responders (>50% reduction in AHI but AHI > 10 events/h), and 29 nonresponders (change in AHI <50% and AHI ≥ 10 events/h). About 62% (45/72) of participants had minimal inspiratory tongue movement (<1 mm) in the neutral position, and this increased to 72% (52/72) after advancing the mandible. Mandibular advancement altered inspiratory tongue movement pattern for 40% (29/72) of participants. When tongue dilatory patterns altered with advancement, 80% (4/5) of those who changed to a counterproductive movement pattern (posterior movement >1 mm) were nonresponders and 71% (5/7) of those who changed to beneficial (anterior movement >1 mm) were partial or complete responders. CONCLUSIONS The mandibular advancement action on upper airway dilator muscles differs between individuals. When mandibular advancement alters inspiratory tongue movement, therapeutic response to MAS therapy was more common among those who convert to a beneficial movement pattern.
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Affiliation(s)
- Lauriane Jugé
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jade Yeung
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Fiona L Knapman
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter G R Burke
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Aimee B Lowth
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ken Z C Gan
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Respiratory and Sleep Medicine Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Joachim Ngiam
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kate Sutherland
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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20
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Gandevia S. Publications, replication and statistics in physiology plus two neglected curves. J Physiol 2021; 599:1719-1721. [DOI: 10.1113/jp281360] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Simon Gandevia
- Neuroscience Research Australia Sydney New South Wales Australia
- University of New South Wales Sydney Australia
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21
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A Modified Cosmetic Genioplasty Can Affect Airway Space Positively in Skeletal Class II Patients: Studying Alterations of Hyoid Bone Position and Posterior Airway Space. Aesthetic Plast Surg 2020; 44:1639-1655. [PMID: 32472313 DOI: 10.1007/s00266-020-01790-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Improving the posterior airway space is one of the most important functions of genioplasty. Studies have shown that the posterior airway space (PAS) can play an important role in the evaluation of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to evaluate the airway safety of our modified technology by observing the impact on PAS in skeletal Class II patients without OSAS. METHODS We have modified a cosmetic genioplasty, which can guarantee the continuity of the lower edge of the bilateral mandible by rotating the chin segment clockwise. Fourteen patients submitted to our modified cosmetic genioplasty alone were included in the study. The facial convexity angle and the ratio of the face were measured by analyzing photographs. The position of the hyoid bone and the width of the PAS were measured by analyzing lateral cephalograms. The volume and the cross-sectional area (CSA) of the PAS were measured using 3D reconstruction. The Wilcoxon signed-rank test and paired samples t test were used to assess the significance of differences of the data (p < 0.05). RESULTS Soft tissue measurements were statistically different (p = 0.001) and achieved satisfactory results. The position of the hyoid bone moved up (LX: p = 0.004; LML: p = 0.056) and forward (LY: p = 0.001; LCV3: p = 0.016). The increase in the CSA had statistical significance (p < 0.005). There were significant statistical differences in the total airway volume and hypopharynx (p = 0.001), except in the oropharynx (p = 0.096). CONCLUSIONS Our modified genioplasty not only achieved better cosmetic results by ensuring the continuity of the lower edge of the bilateral mandible but also exerted a significant positive impact on the posterior airway space for patients with skeletal class II, thus helping reduce the prevalence of OSAS. We hence suggest performing this modified cosmetic genioplasty on the skeletal class II patients with/without OSAS if necessary. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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22
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Dontsos VK, Chatzigianni A, Papadopoulos MA, Nena E, Steiropoulos P. Upper airway volumetric changes of obstructive sleep apnoea patients treated with oral appliances: a systematic review and meta-analysis. Eur J Orthod 2020; 43:399-407. [PMID: 32524148 DOI: 10.1093/ejo/cjaa035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial upper airway obstruction. Among different treatment options for OSA, Continuous Positive Airway Pressure, and oral appliances (OAs) have been used, with various outcomes and side effects. OBJECTIVE The aim of this study was to summarize current knowledge in an evidence-based manner regarding the upper airway volume increase of OSA patients while treated with OAs. SEARCH METHODS Electronic search was conducted in Pubmed, Cochrane Library, and Scopus, up to May 2020. SELECTION CRITERIA Studies were selected after the application of predetermined eligibility criteria. DATA COLLECTION AND ANALYSIS Mean airway volume differences and the corresponding 95% confidence intervals were calculated, using the random effects model. Sensitivity, exploratory, and meta-regression analyses were also implemented. RESULTS Eleven studies filled the inclusion criteria and were included in the systematic review, while 10 of them were suitable for meta-analysis. In total, 291 patients were included, with mean upper airway volume increase of 1.95 cm3 (95% CI, 1.37-2.53; P < 0.001) with Mandibular Advancement Devices in place. In all studies, post-treatment Apnea Hypopnea Index (AHI) was either <10 events/hour or was reduced by more than 50% from baseline levels. A greater increase of the velopharynx volume was observed, regarding airway compartments. CONCLUSIONS Treatment with OAs in OSA may lead to a significant increase of the upper airway volume with a subsequent decrease of AHI. The velopharynx seems to be affected the most from OA therapy.
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Affiliation(s)
- Vasileios K Dontsos
- Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Athina Chatzigianni
- Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Moschos A Papadopoulos
- Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
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23
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Manlises CO, Chen J, Huang C. Dynamic tongue area measurements in ultrasound images for adults with obstructive sleep apnea. J Sleep Res 2020; 29:e13032. [DOI: 10.1111/jsr.13032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/09/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Cyrel Ontimare Manlises
- Department of Biomedical Engineering National Cheng Kung University Tainan Taiwan
- School of Electrical, Electronics, and Computer Engineering Mapúa University Manila Philippines
| | - Jeng‐Wen Chen
- Department of Otolaryngology–Head and Neck Surgery Cardinal Tien Hospital New Taipei City Taiwan
- School of Medicine Fu Jen Catholic University New Taipei City Taiwan
- Department of Otolaryngology–Head and Neck Surgery National Taiwan University Hospital Taipei Taiwan
- Department of Nursing Cardinal Tien Junior College of Healthcare and Management New Taipei City Taiwan
| | - Chih‐Chung Huang
- Department of Biomedical Engineering National Cheng Kung University Tainan Taiwan
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24
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Garner DP, Lamira J. Respiratory outcomes with the use of a lower custom fit genioglossal-effecting oral appliance. Clin Exp Dent Res 2020; 6:100-106. [PMID: 32067401 PMCID: PMC7025983 DOI: 10.1002/cre2.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Sleep apnea research cites that an oral appliance, which places the mandible in a more forward position and the genioglossus (tongue muscle) on the floor of the mouth, improves aspects of the pharyngeal opening. Exercise science research has cited improvements in airway dynamics and physiological variables with oral appliance use during exercise. Thus, the purpose of this study was to design an oral appliance that would act on the genioglossus and determine if there were effects on respiratory parameters while exercising. MATERIALS AND METHODS Seventeen healthy subjects ages 18-43 participated in this study. Prior to the exercise protocol, the order of the oral applicance (OA) or no oral appliance (no OA) condition was randomly assigned to subjects, with subjects completing both conditions. Respiratory parameters (respiratory rate, ventilation, oxygen, and carbon dioxide) were measured between conditions while subjects ran for 10 min at steady state. RESULTS The results demonstrated that both respiratory rate (25.97 BPM, OA and 28.35 BPM, no OA) and ventilation (47.66 l/min, OA and 50.34 l/min, No OA) were significantly lowered (p < .01) in the OA condition. There were no differences in carbon dioxide (1.89 l/min, no OA and 1.88 l/min, OA) or oxygen outcomes (2.17 l/min, no OA and 2.17 l/min OA). DISCUSSION The outcomes from this study suggest that the design of the oral appliance elicits an effect on the genioglossus, thereby resulting in lowered respiratory rate and ventilation with no negative effects on oxygen uptake during exercise.
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Affiliation(s)
- Dena P. Garner
- Department of Health and Human Performance, the CitadelThe CitadelCharlestonSouth Carolina
| | - Jensine Lamira
- Department of Health and Human Performance, the CitadelThe CitadelCharlestonSouth Carolina
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25
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Jugé L, Knapman FL, Burke PG, Brown E, Bosquillon de Frescheville AF, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Regional respiratory movement of the tongue is coordinated during wakefulness and is larger in severe obstructive sleep apnoea. J Physiol 2020; 598:581-597. [DOI: 10.1113/jp278769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lauriane Jugé
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
| | - Fiona L. Knapman
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
| | - Peter G.R. Burke
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
- Biomedical Sciences Department Administration Macquarie University Sydney New South Wales Australia
| | - Elizabeth Brown
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Hospital Sydney New South Wales Australia
| | | | - Simon C. Gandevia
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
| | - Danny J. Eckert
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
- Adelaide Institute for Sleep Health Flinders University Adelaide Australia
| | - Jane E. Butler
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
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26
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Cheng S, Kourmatzis A, Mekonnen T, Gholizadeh H, Raco J, Chen L, Tang P, Chan HK. Does upper airway deformation affect drug deposition? Int J Pharm 2019; 572:118773. [PMID: 31678391 DOI: 10.1016/j.ijpharm.2019.118773] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022]
Abstract
Knowledge that enables the accurate simulation of drug deposition in the human upper airway is necessary to develop robust platforms for efficient drug delivery by inhalation devices. The human upper airway is deformable during inhalation but how it could affect the deposition of inhaled drugs is unknown. We aimed to determine whether pharyngeal deformation at the soft palate level would have any significant effects on throat deposition, in vitro lung dose and fine particle fraction. In this study, dry mannitol powders were delivered to the next-generation cascade impactor (NGI) through the United States Pharmacopeia (USP) throat, and a realistic upper airway cast (RUPAC) at flow rates of 40, 60 and 80 L min-1. Deformation of the upper airway at 25%, 50%, and 75% in the lateral and antero-posterior directions were experimentally simulated in the RUPAC. Throat deposition (p = 0.04) is significantly affected when the upper airway deforms laterally but not antero-posteriorly.
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Affiliation(s)
- Shaokoon Cheng
- Macquarie University, School of Engineering, Faculty of Science and Engineering Sydney, Australia
| | - Agisilaos Kourmatzis
- University of Sydney, School of Aerospace, Mechanical and Mechatronic Engineering, Sydney, Australia
| | - Taye Mekonnen
- Macquarie University, School of Engineering, Faculty of Science and Engineering Sydney, Australia
| | - Hanieh Gholizadeh
- Macquarie University, School of Engineering, Faculty of Science and Engineering Sydney, Australia
| | - Joel Raco
- Macquarie University, School of Engineering, Faculty of Science and Engineering Sydney, Australia
| | - Lan Chen
- Hangzhou Chance Pharmaceuticals, Hangzhou, China
| | - Patricia Tang
- University of Sydney, Sydney Pharmacy School, Advanced Drug Delivery Group, Sydney, Australia
| | - Hak-Kim Chan
- University of Sydney, Sydney Pharmacy School, Advanced Drug Delivery Group, Sydney, Australia.
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27
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Tong J, Jugé L, Burke PG, Knapman F, Eckert DJ, Bilston LE, Amatoury J. Respiratory-related displacement of the trachea in obstructive sleep apnea. J Appl Physiol (1985) 2019; 127:1307-1316. [PMID: 31513451 DOI: 10.1152/japplphysiol.00660.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Tracheal displacement is thought to be the primary mechanism by which changes in lung volume influence upper airway patency. Caudal tracheal displacement during inspiration may help preserve the integrity of the upper airway in response to increasing negative airway pressure by stretching and stiffening pharyngeal tissues. However, tracheal displacement has not been previously quantified in obstructive sleep apnea (OSA). Accordingly, we aimed to measure tracheal displacements in awake individuals with and without OSA. The upper head and neck of 34 participants [apnea-hypopnea index (AHI) = 2-74 events/h] were imaged in the midsagittal plane using dynamic magnetic resonance imaging (MRI) during supine awake quiet breathing. MRI data were analyzed to identify peak tracheal displacement and its timing relative to inspiration. Epiglottic pressure was measured separately for a subset of participants (n = 30) during similar experimental conditions. Nadir epiglottic pressure and its timing relative to inspiration were quantified. Peak tracheal displacement ranged from 1.0-9.6 mm, with a median (25th-75th percentile) of 2.3 (1.7-3.5) mm, and occurred at 89 (78-99)% of inspiratory time. Peak tracheal displacement increased with increasing OSA severity (AHI) (R2 = 0.28, P = 0.013) and increasing negative nadir epiglottic pressure (R2 = 0.47, P = 0.023). Relative inspiratory timing of peak tracheal displacement also correlated with OSA severity, with peak displacement occurring earlier in inspiration with increasing AHI (R2 = 0.36, P = 0.002). Tracheal displacements during quiet breathing are larger in individuals with more severe OSA and tend to reach peak displacement earlier in the inspiratory cycle. Increased tracheal displacement may contribute to maintenance of upper airway patency during wakefulness in OSA, particularly in those with severe disease.NEW & NOTEWORTHY Tracheal displacement is thought to play an important role in stabilizing the upper airway by stretching/stiffening the pharyngeal musculature. Using dynamic magnetic resonance imaging, this study shows that caudal tracheal displacement is more pronounced during inspiration in obstructive sleep apnea (OSA) compared with healthy individuals. Softer pharyngeal muscles and greater inspiratory forces in OSA may underpin greater tracheal excursion. These findings suggest that tracheal displacement may contribute to maintenance of pharyngeal patency during wakefulness in OSA.
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Affiliation(s)
- Joshua Tong
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Gr Burke
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Knapman
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Amatoury
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon
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28
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Kim J, Hegland K, Vann W, Berry R, Davenport PW. Measurement of maximum tongue protrusion force (MTPF) in healthy young adults. Physiol Rep 2019; 7:e14175. [PMID: 31293083 PMCID: PMC6640594 DOI: 10.14814/phy2.14175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
We propose that tongue protrusive strength and tone may be related to upper airway patency, and when protrusive strength is reduced, individuals are at higher risk of developing sleep apnea, or speech/swallow disorders. The goal of the current study was to determine normative values of maximum tongue protrusion force (MTPF) in healthy young adults, using a unique newly developed device. We hypothesized that MTPF would be greater in males than in females. One hundred and one healthy young adults (mean age: 22.99 years; male: 23, female: 78) participated in this study. The subjects pushed their tongue forward against the device’s piston (protrusion) as hard as possible for 2–5 sec and MTPF was recorded in Newtons (N). A minimum of 5 MTPF measurements were obtained with 1–2 min rest between measurements. The average MTPF for all subjects was 15.4 N (SD: ±3.8), with a range of 8–29. The male average MTPF was higher than female (17.8 N, SD: ±3.7 vs. 14.7 N, SD: ±3.5; P = 0.001). There was no significant difference for age between males and females; males had significantly greater height and weight. The results demonstrate our novel device can effectively measure tongue protrusive force in healthy young adults. This study provides normative values for MTPF, and identified significant tongue protrusion strength differences between males and females.
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Affiliation(s)
- Jayoung Kim
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Florida
| | - Karen Hegland
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Florida
| | - William Vann
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Richard Berry
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
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29
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Kwan BCH, Jugé L, Gandevia SC, Bilston LE. Sagittal Measurement of Tongue Movement During Respiration: Comparison Between Ultrasonography and Magnetic Resonance Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:921-934. [PMID: 30691918 DOI: 10.1016/j.ultrasmedbio.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
The tongue makes up the anterior pharyngeal wall and is critical for airway patency. Magnetic resonance imaging (MRI) is commonly used to study pharyngeal muscle function in pharyngeal disorders such as obstructive sleep apnoea. Tagged MRI and ultrasound studies have separately revealed ∼1 mm of anterior tongue movement during inspiration in healthy patients, but these modalities have not been directly compared. In the study described here, agreement between ultrasound and MRI in measuring regional tongue displacement in 21 healthy patients and 21 patients with obstructive sleep apnoea was evaluated. We found good consistency and agreement between the two techniques, with an intra-class correlation coefficient of 0.79 (95% confidence interval: 0.75-0.82) for anteroposterior tongue motion during inspiration. Ultrasound measurements of posterior tongue displacement were 0.24 ± 0.64 mm greater than MRI measurements (95% limits of agreement: 1.03 to -1.49). This may reflect the higher spatial and temporal resolution of the ultrasound technique. This study confirms that ultrasound is a suitable method for quantifying inspiratory tongue movement.
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Affiliation(s)
- Benjamin C H Kwan
- Neuroscience Research Australia, Sydney, New South Wales, Australia; Prince of Wales Hospital Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
| | - Lauriane Jugé
- Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia; Prince of Wales Hospital Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia; Prince of Wales Hospital Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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30
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Kim YC. Fast upper airway magnetic resonance imaging for assessment of speech production and sleep apnea. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2018.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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31
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Ichikawa T, Yokoba M, Kimura M, Shibuya M, Easton PA, Katagiri M. Genioglossus muscle activity during sniff and reverse sniff in healthy men. Exp Physiol 2018; 103:1656-1665. [PMID: 30242925 DOI: 10.1113/ep086995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/20/2018] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Maximal sniff nasal inspiratory and reverse sniff nasal expiratory pressures are measured as inspiratory and expiratory muscle strength, respectively. Is the genioglossus muscle activated during short maximal inspiratory and expiratory efforts through the nose? What is the main finding and its importance? Genioglossus muscle activity occurred with inspiratory muscle activity during a maximal sniff and with expiratory muscle activity during a maximal reverse sniff. These results indicate that genioglossus muscle activity is closely related to the generation of maximal sniff nasal inspiratory and reverse sniff nasal expiratory pressures. ABSTRACT Maximal sniff nasal inspiratory pressure (SNIPmax ) is widely used to assess inspiratory muscle strength. The sniff nasal inspiratory pressure (SNIP) is lower in patients with neuromuscular disease with bulbar involvement compared with those without, possibly owing to impaired upper airway muscle function. However, the degree to which the genioglossus (GG) muscle, one of the upper airway muscles, is activated during inspiratory and expiratory efforts through the nose remains unclear. Therefore, we examined GG activity during short and sharp inspiratory and expiratory efforts through the nose, i.e. sniff and reverse sniff manoeuvres. In eight normal young subjects, we inserted fine wire electrodes into the GG muscle, parasternal intercostal and scalene (inspiratory) muscles and transversus abdominis (expiratory) muscle. We assessed EMG activity of each muscle and measured SNIP and reverse sniff nasal expiratory pressure (RSNEP) during sniffs and reverse sniffs from low to high intensities in the sitting position. The highest SNIP and RSNEP were analysed as SNIPmax and maximal RSNEP (RSNEPmax ), respectively. In each subject, GG EMG activity increased linearly with increasing SNIP and RSNEP. The SNIPmax and RSNEPmax were -85.1 ± 15.9 and 83.2 ± 24.2 cmH2 O, respectively. Genioglossus EMG activity varied with EMG activity of the parasternal intercostal and scalene muscles during generation of SNIPmax and with EMG activity of the transversus abdominis muscle during RSNEPmax . Genioglossus EMG activity during generation of SNIPmax was higher than during RSNEPmax (62.9 ± 31.1% EMG of SNIPmax , P = 0.012). These results suggested that GG activity was closely related to the generation of both SNIPmax and RSNEPmax .
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Affiliation(s)
- Tsuyoshi Ichikawa
- School of Allied Health Sciences, Kitasato University, Kanagawa, Japan.,Rehabilitation Centre, Tokai University Oiso Hospital, Kanagawa, Japan
| | - Masanori Yokoba
- School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | | | - Manaka Shibuya
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Paul A Easton
- Department of Critical Care, University of Calgary, Calgary, Alberta, Canada
| | - Masato Katagiri
- School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
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32
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Tan K, Jugé L, Hatt A, Cheng S, Bilston LE. Measurement of large strain properties in calf muscles in vivo using magnetic resonance elastography and spatial modulation of magnetization. NMR IN BIOMEDICINE 2018; 31:e3925. [PMID: 29675978 DOI: 10.1002/nbm.3925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Abstract
It is important to measure the large deformation properties of skeletal muscle in vivo in order to understand and model movement and the force-producing capabilities of muscle. As muscle properties are non-linear, an understanding of how the deformation state affects the measured shear moduli is also useful for clinical applications of magnetic resonance elastography (MRE) to muscle disorders. MRE has so far only been used to measure the linear viscoelastic (small strain) properties of muscles. This study aims to measure the shear moduli of human calf muscles under varying degrees of strain using MRE. Nine healthy adults (four males; age range, 25-38 years) were recruited, and the storage modulus G' was measured at three ankle angle positions: P0 (neutral), P15 (15° plantarflexed) and P30 (30° plantarflexed). Spatial modulation of magnetization (SPAMM) was used to measure the strain in the calf associated with the ankle rotations between P0 to P15 and P0 to P30. SPAMM results showed that, with plantarflexion, there was a shortening of the medial gastrocnemius and soleus muscles, which resulted in an expansion of both muscles in the transverse direction. Strains for each ankle rotation were in the range 3-9% (in compression). MRE results showed that this shortening during plantarflexion resulted in a mean decrease in G' in the medial gastrocnemius (p = 0.013, linear mixed model), but not in the soleus (p = 0.47). This study showed that MRE is a viable technique for the measurement of large strain deformation properties in vivo in soft tissues by inducing physiological strain within the muscle during imaging.
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Affiliation(s)
- Kristy Tan
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, School of Medical Sciences, Kensington, NSW, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, School of Medical Sciences, Kensington, NSW, Australia
| | - Alice Hatt
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Shaokoon Cheng
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Engineering, Faculty of Science and Engineering, Macquarie University, NSW, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Prince of Wales Clinical School, Kensington, NSW, Australia
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33
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Kwan BCH, McBain RA, Luu BL, Butler JE, Bilston LE, Gandevia SC. Influence of respiratory mechanics and drive on genioglossus movement under ultrasound imaging. PLoS One 2018; 13:e0195884. [PMID: 29659626 PMCID: PMC5901985 DOI: 10.1371/journal.pone.0195884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/30/2018] [Indexed: 11/18/2022] Open
Abstract
METHODS Twenty healthy subjects (10 males, age 28±5 years [mean ± SD]) lay supine, awake, with the head in a neutral position. Ventilation was monitored with inductance bands. Real-time B-mode ultrasound movies were analysed. We measured genioglossus motion (i) during spontaneous breathing, voluntary targeted breathing (normal tidal volume Vt), and voluntary hyperpnoea (at 1.5Vt and 2 Vt); (ii) during inspiratory flow resistive loading; (iii) with changes in end-expiratory lung volume (EELV). RESULTS Average peak inspiratory displacement of the infero-posterior region of genioglossus was 0.89±0.56 mm; 1.02±0.88 mm; 1.27±0.70 mm respectively for voluntary Vt, and during voluntary hyperpnoea at 1.5Vt and 2Vt. A change in genioglossus motion was observed with increased Vt. During increasing inspiratory resistive loading, the genioglossus displaced less anteriorly (p = 0.005) but more inferiorly (p = 0.027). When lung volume was altered, no significant changes in genioglossus movement were observed (p = 0.115). CONCLUSION In healthy subjects, we observed non-uniform heterogeneous inspiratory motion within the inferoposterior part of genioglossus during spontaneous quiet breathing with mean peak displacement between 0.5-2 mm, with more displacement in the posterior region than the anterior. This regional heterogeneity disappeared during voluntary targeted breathing. This may be due to different neural drive to genioglossus during voluntary breathing. During inspiratory resistive loading, the observed genioglossus motion may serve to maintain upper airway patency by balancing intraluminal negative pressure with positive pressure generated by upper airway dilatory muscles. In contrast, changes in EELV were not accompanied by major changes in genioglossus motion.
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Affiliation(s)
- Benjamin C. H. Kwan
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- * E-mail:
| | - Rachel A. McBain
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
| | - Billy L. Luu
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
| | - Jane E. Butler
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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34
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Luu BL, Muceli S, Saboisky JP, Farina D, Héroux ME, Bilston LE, Gandevia SC, Butler JE. Motor unit territories in human genioglossus estimated with multichannel intramuscular electrodes. J Appl Physiol (1985) 2018; 124:664-671. [DOI: 10.1152/japplphysiol.00889.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The discharge patterns of genioglossus motor units during breathing have been well-characterized in previous studies, but their localization and territories are not known. In this study, we used two newly developed intramuscular multichannel electrodes to estimate the territories of genioglossus motor units in the anterior and posterior regions of the muscle. Seven healthy men participated. Each electrode contained fifteen bipolar channels, separated by 1 mm, and was inserted percutaneously below the chin, perpendicular to the skin, to a depth of 36 mm. Single motor unit activity was recorded with subjects awake, supine, and breathing quietly through a nasal mask for 180 s. Motor unit territories were estimated from the spike-triggered averages of the electromyographic signal from each channel. A total of 30 motor units were identified: 22 expiratory tonic, 1 expiratory phasic, 2 tonic, 3 inspiratory tonic, and 2 inspiratory phasic. Motor units appeared to be clustered based on unit type, with peak activities for expiratory units predominantly located in the anterior and superficial fibers of genioglossus and inspiratory units in the posterior region. Of these motor unit types, expiratory tonic units had the largest estimated territory, a mean 11.3 mm (SD 1.9). Estimated territories of inspiratory motor units ranged from 3 to 6 mm. In accordance with the distribution of motor unit types, the estimated territory of genioglossus motor units varied along the sagittal plane, decreasing from anterior to posterior. Our findings suggest that genioglossus motor units have large territories relative to the cross-sectional size of the muscle. NEW & NOTEWORTHY In this study, we used a new multichannel intramuscular electrode to address a fundamental property of human genioglossus motor units. We describe the territory of genioglossus motor units in the anterior and posterior regions of the muscle and show a decrease in territory size from anterior to posterior and that expiratory-related motor units have larger estimated territories than inspiratory-related motor units.
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Affiliation(s)
- Billy L. Luu
- Neuroscience Research Australia, Randwick, and University of New South Wales, Sydney, Australia
| | - Silvia Muceli
- Neurorehabilitation Systems Research Group, Clinic for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Julian P. Saboisky
- Neuroscience Research Australia, Randwick, and University of New South Wales, Sydney, Australia
| | - Dario Farina
- Neurorehabilitation Systems Research Group, Clinic for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Martin E. Héroux
- Neuroscience Research Australia, Randwick, and University of New South Wales, Sydney, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia, Randwick, and University of New South Wales, Sydney, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia, Randwick, and University of New South Wales, Sydney, Australia
| | - Jane E. Butler
- Neuroscience Research Australia, Randwick, and University of New South Wales, Sydney, Australia
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Abstract
The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing (high loop gain). Each of these phenotypes is a target for therapy. This review summarizes the latest knowledge on the different contributors to OSA with a focus on measurement techniques including emerging clinical tools designed to facilitate translation of new cause-driven targeted approaches to treat OSA. The potential for some of the specific pathophysiological causes of OSA to drive some of the key symptoms and consequences of OSA is also highlighted.
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Affiliation(s)
- Amal M Osman
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Sophie G Carter
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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Kourmatzis A, Cheng S, Chan HK. Airway geometry, airway flow, and particle measurement methods: implications on pulmonary drug delivery. Expert Opin Drug Deliv 2017; 15:271-282. [DOI: 10.1080/17425247.2018.1406917] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Kourmatzis
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, Australia
| | - S. Cheng
- Department of Engineering, Macquarie University, Sydney, Australia
| | - H.-K. Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, Australia
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Chen H, van Eijnatten M, Wolff J, de Lange J, van der Stelt PF, Lobbezoo F, Aarab G. Reliability and accuracy of three imaging software packages used for 3D analysis of the upper airway on cone beam computed tomography images. Dentomaxillofac Radiol 2017; 46:20170043. [PMID: 28467118 DOI: 10.1259/dmfr.20170043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the reliability and accuracy of three different imaging software packages for three-dimensional analysis of the upper airway using CBCT images. METHODS To assess the reliability of the software packages, 15 NewTom 5G® (QR Systems, Verona, Italy) CBCT data sets were randomly and retrospectively selected. Two observers measured the volume, minimum cross-sectional area and the length of the upper airway using Amira® (Visage Imaging Inc., Carlsbad, CA), 3Diagnosys® (3diemme, Cantu, Italy) and OnDemand3D® (CyberMed, Seoul, Republic of Korea) software packages. The intra- and inter-observer reliability of the upper airway measurements were determined using intraclass correlation coefficients and Bland & Altman agreement tests. To assess the accuracy of the software packages, one NewTom 5G® CBCT data set was used to print a three-dimensional anthropomorphic phantom with known dimensions to be used as the "gold standard". This phantom was subsequently scanned using a NewTom 5G® scanner. Based on the CBCT data set of the phantom, one observer measured the volume, minimum cross-sectional area, and length of the upper airway using Amira®, 3Diagnosys®, and OnDemand3D®, and compared these measurements with the gold standard. RESULTS The intra- and inter-observer reliability of the measurements of the upper airway using the different software packages were excellent (intraclass correlation coefficient ≥0.75). There was excellent agreement between all three software packages in volume, minimum cross-sectional area and length measurements. All software packages underestimated the upper airway volume by -8.8% to -12.3%, the minimum cross-sectional area by -6.2% to -14.6%, and the length by -1.6% to -2.9%. CONCLUSIONS All three software packages offered reliable volume, minimum cross-sectional area and length measurements of the upper airway. The length measurements of the upper airway were the most accurate results in all software packages. All software packages underestimated the upper airway dimensions of the anthropomorphic phantom.
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Affiliation(s)
- Hui Chen
- 1 Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands.,2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands
| | - Maureen van Eijnatten
- 3 3D Innovation Lab, Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Center, University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands
| | - Jan Wolff
- 3 3D Innovation Lab, Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Center, University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands
| | - Jan de Lange
- 4 Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam (ACTA) and Academic Medical Center (AMC), University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands
| | - Paul F van der Stelt
- 1 Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands
| | - Frank Lobbezoo
- 2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands
| | - Ghizlane Aarab
- 2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Netherlands
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Chen H, Aarab G, de Ruiter MHT, de Lange J, Lobbezoo F, van der Stelt PF. Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review. Sleep Med 2016; 21:19-27. [PMID: 27448467 DOI: 10.1016/j.sleep.2016.01.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/28/2015] [Accepted: 01/16/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The pathogenesis of upper airway collapse in people with obstructive sleep apnea (OSA) is not fully understood. The aim of this study was to systematically review the literature in order to assess the most relevant anatomical characteristics of the upper airway related to the pathogenesis of OSA by analyzing the three-dimensional upper airway anatomy. METHOD A PICO (population/patient, intervention, comparison, outcome) search strategy, focusing on the upper airway anatomy of people with OSA, was conducted using the following databases: MEDLINE (PubMed), Excerpta Medica database (EMBASE), Web of Science, and Cochrane Library. The studies in which three-dimensional images were made from the participants who were awake and in the supine position during quiet breathing were selected in this systematic review. RESULTS Of the 758 unique retrieved studies, eight fulfilled the criteria for this systematic review. The minimum cross-sectional area of the upper airways of people with OSA, which is influenced by many factors such as hard and soft tissues surrounding the upper airway, was significantly smaller than that of those without OSA. CONCLUSION Within the limitation of the selected studies, this systematic review suggested that a small minimum cross-sectional area is the most relevant anatomical characteristic of the upper airway related to the pathogenesis of OSA.
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Affiliation(s)
- Hui Chen
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands.
| | - Ghizlane Aarab
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Maurits H T de Ruiter
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Paul F van der Stelt
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands
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Cai M, Brown EC, Hatt A, Cheng S, Bilston LE. Effect of head and jaw position on respiratory-related motion of the genioglossus. J Appl Physiol (1985) 2016; 120:758-65. [DOI: 10.1152/japplphysiol.00382.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 01/19/2016] [Indexed: 11/22/2022] Open
Abstract
Head and jaw position influence upper airway patency and electromyographic (EMG) activity of the main upper airway dilator muscle, the genioglossus. However, it is not known whether changes in genioglossus EMG activity translate into altered muscle movement during respiration. The aim of this study was to determine the influence of head and jaw position on dilatory motion of the genioglossus in healthy adult men during quiet breathing by measuring the displacement of the posterior tongue in six positions—neutral, head extension, head rotation, head flexion, mouth opening, and mandibular advancement. Respiratory-related motion of the genioglossus was imaged with spatial modulation of magnetization (SPAMM) in 12 awake male participants. Tissue displacement was quantified with harmonic phase (HARP) analysis. The genioglossus moved anteriorly beginning immediately before or during inspiration, and there was greater movement in the oropharynx than in the velopharynx in all positions. Anterior displacements of the oropharyngeal tongue varied between neutral head position (0.81 ± 0.41 mm), head flexion (0.62 ± 0.45 mm), extension (0.39 ± 0.19 mm), axial rotation (0.39 ± 0.2 mm), mouth open (1.24 ± 0.72 mm), and mandibular advancement (1.08 ± 0.65 mm). Anteroposterior displacement increased in the mouth-open position and decreased in the rotated position relative to cross-sectional area (CSA) ( P = 0.002 and 0.02, respectively), but CSA did not independently predict anteroposterior movement overall ( P = 0.057). The findings of this study suggest that head position influences airway dilation during inspiration and may contribute to variation in airway patency in different head positions.
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Affiliation(s)
- Mingshu Cai
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
| | - Elizabeth C. Brown
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
| | - Alice Hatt
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
| | - Shaokoon Cheng
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
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40
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Carter SG, Berger MS, Carberry JC, Bilston LE, Butler JE, Tong BKY, Martins RT, Fisher LP, McKenzie DK, Grunstein RR, Eckert DJ. Zopiclone Increases the Arousal Threshold without Impairing Genioglossus Activity in Obstructive Sleep Apnea. Sleep 2016; 39:757-66. [PMID: 26715227 DOI: 10.5665/sleep.5622] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/20/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To determine the effects of the nonbenzodiazepine sedative zopiclone on the threshold to arousal with increasing respiratory effort and genioglossus muscle activity and to examine potential physiological factors mediating disparate effects of zopiclone on obstructive sleep apnea (OSA) severity between patients. METHODS Twelve patients with OSA (apnea-hypopnea index = 41 ± 8 events/h) were studied during 2 single night sleep studies conducted approximately 1 w apart after receiving 7.5 mg of zopiclone or placebo according to a double-blind, placebo-controlled, randomized, crossover design. The respiratory arousal threshold (epiglottic pressure immediately prior to arousal during naturally occurring respiratory events), genioglossus activity and its responsiveness to pharyngeal pressure during respiratory events, and markers of OSA severity were compared between conditions. Genioglossus movement patterns and upper airway anatomy were also assessed via magnetic resonance imaging in a subset of participants (n = 7) during wakefulness. RESULTS Zopiclone increased the respiratory arousal threshold versus placebo (-31.8 ± 5.6 versus -26.4 ± 4.6 cmH2O, P = 0.02) without impairing genioglossus muscle activity or its responsiveness to negative pharyngeal pressure during respiratory events (-0.56 ± 0.2 versus -0.44 ± 0.1 %max/-cmH2O, P = 0.48). There was substantial interindividual variability in the changes in OSA severity with zopiclone explained, at least in part, by differences in pathophysiological characteristics including body mass index, arousal threshold, and genioglossus movement patterns. CONCLUSIONS In a group of patients with predominantly severe OSA, zopiclone increased the arousal threshold without reducing genioglossus muscle activity or its responsiveness to negative pharyngeal pressure. These properties may be beneficial in some patients with OSA with certain pathophysiological characteristics but may worsen hypoxemia in others. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au, trial ID: ACTRN12614000364673.
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Affiliation(s)
- Sophie G Carter
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - Michael S Berger
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - Benjamin K Y Tong
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - Rodrigo T Martins
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - Lauren P Fisher
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - David K McKenzie
- Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research and the University of Sydney, Glebe, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
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Bordoni B, Zanier E. The continuity of the body: hypothesis of treatment of the five diaphragms. J Altern Complement Med 2015; 21:237-42. [PMID: 25775273 DOI: 10.1089/acm.2013.0211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The diaphragm muscle should not be seen as a segment but as part of a body system. This muscle is an important crossroads of information for the entire body, from the trigeminal system to the pelvic floor, passing from thoracic diaphragm to the floor of the mouth: the network of breath. Viola Frymann first spoke of the treatment of three diaphragms, and more recently four diaphragms have been discussed. Current scientific knowledge has led to discussion of the manual treatment of five diaphragms. This article highlights the anatomic connections and fascial and neurologic aspects of the diaphragm muscle, with four other structures considered as diaphragms: that is, the five diaphragms. The logic of the manual treatment proposed here is based on a concept and diagnostic work that should be the basis for any area of the body: The patient never just has a localized symptom but rather a system that adapts to a question.
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Affiliation(s)
- Bruno Bordoni
- 1 Don Carlo Gnocchi IRCCS , Department of Cardiology, IRCCS S. Maria Nascente, Don Carlo Gnocchi Foundation, Milano, Italy
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42
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Saboisky JP, Butler JE, Luu BL, Gandevia SC. Neurogenic Changes in the Upper Airway of Obstructive Sleep Apnoea. Curr Neurol Neurosci Rep 2015; 15:12. [DOI: 10.1007/s11910-015-0537-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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43
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Vranish JR, Bailey EF. A comprehensive assessment of genioglossus electromyographic activity in healthy adults. J Neurophysiol 2015; 113:2692-9. [PMID: 25695653 DOI: 10.1152/jn.00975.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/12/2015] [Indexed: 12/23/2022] Open
Abstract
The genioglossus (GG) is an extrinsic muscle of the human tongue that plays a critical role in preserving airway patency. In the last quarter century, >50 studies have reported on respiratory-related GG electromyographic (EMG) activity in human subjects. Remarkably, of the studies performed, none have duplicated subject body position, electrode recording locations, and/or breathing task(s), making interpretation and integration of the results across studies extremely challenging. In addition, more recent research assessing lingual anatomy and muscle contractile properties has identified regional differences in muscle fiber type and myosin heavy chain expression, giving rise to the possibility that the anterior and posterior regions of the muscle fulfill distinct functions. Here, we assessed EMG activity in anterior and posterior regions of the GG, across upright and supine, in rest breathing and in volitionally modulated breathing tasks. We tested the hypotheses that GG EMG is greater in the posterior region and in supine, except when breathing is subject to volitional modulation. Our results show differences in the magnitude of EMG (%regional maximum) between anterior and posterior muscle regions (7.95 ± 0.57 vs. 11.10 ± 0.99, respectively; P < 0.001), and between upright and supine (8.63 ± 0.73 vs. 10.42 ± 0.90, respectively; P = 0.008). Although the nature of a task affects the magnitude of EMG (P < 0.001), the effect is similar for anterior and posterior muscle regions and across upright and supine (P > 0.2).
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Affiliation(s)
- Jennifer R Vranish
- Department of Physiology, College of Medicine, University of Arizona, Tucson, Arizona
| | - E Fiona Bailey
- Department of Physiology, College of Medicine, University of Arizona, Tucson, Arizona
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44
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Effects of tongue position and lung volume on voluntary maximal tongue protrusion force in humans. Respir Physiol Neurobiol 2015; 206:61-6. [DOI: 10.1016/j.resp.2014.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/19/2014] [Accepted: 11/28/2014] [Indexed: 11/23/2022]
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45
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Bilston LE, Tan K. Measurement of passive skeletal muscle mechanical properties in vivo: recent progress, clinical applications, and remaining challenges. Ann Biomed Eng 2014; 43:261-73. [PMID: 25404536 DOI: 10.1007/s10439-014-1186-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/06/2014] [Indexed: 12/30/2022]
Abstract
The ability to measure and quantify the properties of skeletal muscle in vivo as a method for understanding its complex physiological and pathophysiological behavior is important in numerous clinical settings, including rehabilitation. However, this remains a challenge to date due to the lack of a "gold standard" technique. Instead, there are a myriad of measuring techniques each with its own set of pros and cons. This review discusses the current state-of-the-art in elastography imaging techniques, i.e., ultrasound and magnetic resonance elastography, as applied to skeletal muscle, and briefly reviews other methods of measuring muscle mechanical behavior in vivo. While in vivo muscle viscoelastic properties can be measured, these techniques are largely limited to static or quasistatic measurements. Emerging elastography techniques are able to quantify muscle anisotropy and large deformation effects on stiffness, but, validation and optimization of these newer techniques is required. The development of reliable values for the mechanical properties of muscle across the population using these techniques are required to enable them to become more useful in rehabilitation and other clinical settings.
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46
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Cheng S, Brown EC, Hatt A, Butler JE, Gandevia SC, Bilston LE. Healthy humans with a narrow upper airway maintain patency during quiet breathing by dilating the airway during inspiration. J Physiol 2014; 592:4763-74. [PMID: 25217376 DOI: 10.1113/jphysiol.2014.279240] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A patent upper airway is essential for survival. Increased age, obesity and some upper airway anatomical features are associated with failure to maintain upper airway patency during sleep, leading to obstructive sleep apnoea. However, many healthy subjects with these risk factors do not develop this condition. The aim of this study was to determine how anatomical factors and active dilator muscle contraction contribute to upper airway patency in healthy volunteers across a broad range of age and body mass index (BMI). A 'tagged' magnetic resonance imaging technique quantified respiratory-related motion of the anterior and lateral walls of the upper airway during quiet breathing in the supine position. Fifty-two subjects aged 22-68 years with BMI from 17.5 to 40.1 kg m(-2) were studied. Higher BMI was associated with smaller airway cross-sectional area at the level of soft palate (P < 0.05). The genioglossus moved anteriorly to dilate the upper airway during inspiration. This movement increased with increasing BMI, increasing age, a smaller airway area, and steeper tongue-base angle (all P < 0.05). Motion of the lateral upper airway at the soft-palate level was variable and less strongly linked to anatomical features of the upper airway. Multiple regression indicated that anterior genioglossus motion decreased with increasing airway area (P = 0.03) and with increasing tongue-base angle (P = 0.02). These data suggest that healthy humans, including those whose anatomy places them at increased risk of airway closure, can maintain upper airway patency by dynamically dilating the airway during inspiration.
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Affiliation(s)
- Shaokoon Cheng
- Neuroscience Research Australia, Sydney, Australia School of Medical Science, UNSW Medicine, Australia
| | | | - Alice Hatt
- Neuroscience Research Australia, Sydney, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, Australia School of Medical Science, UNSW Medicine, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, Australia Prince of Wales Clinical School, UNSW Medicine, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, Australia Prince of Wales Clinical School, UNSW Medicine, Australia
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47
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Kwan BCH, Butler JE, Hudson AL, McKenzie DK, Bilston LE, Gandevia SC. A novel ultrasound technique to measure genioglossus movement in vivo. J Appl Physiol (1985) 2014; 117:556-62. [DOI: 10.1152/japplphysiol.01257.2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Upper airway muscles are important in maintaining airway patency. Visualization of their dynamic motion should allow measurement, comparison, and further understanding of their roles in healthy subjects and those with upper airway disorders. Currently, there are few clinically feasible real-time imaging methods. Methods such as tagged magnetic resonance imaging have documented movement of genioglossus (GG), the largest upper airway dilator. Inspiratory movement was largest in the posterior region of GG. This study aimed to develop a novel ultrasound (US) method to measure GG movement in real time. We tested 20 healthy, awake subjects (21–38 yr) breathing quietly in the supine posture with the head in a neutral position. US images were collected using a transducer positioned submentally. Image correlation analysis measured regional displacement of GG within a grid of points in the midsagittal plane throughout the respiratory cycle. Typically, motion began before inspiratory flow in an anteroinferior direction and peaked in midinspiration. Average peak displacements of the anterior, posterior, superior, and inferior grid points were 0.44 ± 0.23 (mean ± SD), 0.57 ± 0.35, 0.38 ± 0.20, and 0.62 ± 0.41 mm, respectively. Largest displacements occurred in the most inferoposterior part (0.70 ± 0.48 mm). This method had good intrarater repeatability within the same testing session, as well as across sessions. We have devised a simple noninvasive US method, which should be a useful tool to assess GG movement in normal subjects and those with sleep-disordered breathing.
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Affiliation(s)
- Benjamin C. H. Kwan
- Neuroscience Research Australia, Sydney, New South Wales, Australia; and
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jane E. Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia; and
- University of New South Wales, Sydney, New South Wales, Australia
| | - Anna L. Hudson
- Neuroscience Research Australia, Sydney, New South Wales, Australia; and
- University of New South Wales, Sydney, New South Wales, Australia
| | - David K. McKenzie
- Neuroscience Research Australia, Sydney, New South Wales, Australia; and
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia; and
- University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia; and
- University of New South Wales, Sydney, New South Wales, Australia
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Saboisky JP, Stashuk DW, Hamilton-Wright A, Trinder J, Nandedkar S, Malhotra A. Effects of aging on genioglossus motor units in humans. PLoS One 2014; 9:e104572. [PMID: 25111799 PMCID: PMC4128697 DOI: 10.1371/journal.pone.0104572] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/10/2014] [Indexed: 11/21/2022] Open
Abstract
The genioglossus is a major upper airway dilator muscle thought to be important in obstructive sleep apnea pathogenesis. Aging is a risk factor for obstructive sleep apnea although the mechanisms are unclear and the effects of aging on motor unit remodeled in the genioglossus remains unknown. To assess possible changes associated with aging we compared quantitative parameters related to motor unit potential morphology derived from EMG signals in a sample of older (n = 11; >55 years) versus younger (n = 29; <55 years) adults. All data were recorded during quiet breathing with the subjects awake. Diagnostic sleep studies (Apnea Hypopnea Index) confirmed the presence or absence of obstructive sleep apnea. Genioglossus EMG signals were analyzed offline by automated software (DQEMG), which estimated a MUP template from each extracted motor unit potential train (MUPT) for both the selective concentric needle and concentric needle macro (CNMACRO) recorded EMG signals. 2074 MUPTs from 40 subjects (mean±95% CI; older AHI 19.6±9.9 events/hr versus younger AHI 30.1±6.1 events/hr) were extracted. MUPs detected in older adults were 32% longer in duration (14.7±0.5 ms versus 11.1±0.2 ms; P = 0.05), with similar amplitudes (395.2±25.1 µV versus 394.6±13.7 µV). Amplitudes of CNMACRO MUPs detected in older adults were larger by 22% (62.7±6.5 µV versus 51.3±3.0 µV; P<0.05), with areas 24% larger (160.6±18.6 µV.ms versus 130.0±7.4 µV.ms; P<0.05) than those detected in younger adults. These results confirm that remodeled motor units are present in the genioglossus muscle of individuals above 55 years, which may have implications for OSA pathogenesis and aging related upper airway collapsibility.
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Affiliation(s)
- Julian P. Saboisky
- Division of Sleep Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
| | - Daniel W. Stashuk
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
| | - Andrew Hamilton-Wright
- Mathematics and Computer Science, Mount Allison University, Sackville, New Brunswick, Canada
| | - John Trinder
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Atul Malhotra
- Division of Sleep Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
- University of California San Diego, La Jolla, California, United States of America
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Brennick MJ, Delikatny J, Pack AI, Pickup S, Shinde S, Zhu JX, Roscoe I, Kim DY, Buxbaum LU, Cater JR, Schwab RJ. Tongue fat infiltration in obese versus lean Zucker rats. Sleep 2014; 37:1095-102, 1102A-1102C. [PMID: 24882904 PMCID: PMC4015383 DOI: 10.5665/sleep.3768] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY OBJECTIVES Obesity is the most important risk factor for obstructive sleep apnea (OSA), and the effects of obesity may be mediated by tongue fat. Our objective was to examine the effects of obesity on upper airway structures in obese (OBZ) and non-obese (NBZ) Zucker rats. DESIGN Animal study. SETTING Academic Medical Center. PARTICIPANTS OBZ (638.2 ± 39 g; 14.9 ± 1.1 w) and age-matched NBZ Zucker (442.6 ± 37 g, 15.1 ± 1.5 w) rats. INTERVENTIONS TONGUE FAT AND VOLUME AND WERE ASSESSED USING: in vivo magnetic resonance spectroscopy (MRS), magnetic resonance imaging including Dixon imaging for tongue fat volume, ex vivo biochemistry (fat quantification; triglyceride (mg)/tissue (g), and histology (Oil Red O stain). MEASUREMENTS AND RESULTS MRS: overall OBZ tongue fat/water ratio was 2.9 times greater than NBZ (P < 0.002) with the anterior OBZ tongue up to 3.3 times greater than NBZ (P < 0.002). Biochemistry: Triglyceride (TG) in the tongue was 4.4 times greater in OBZ versus NBZ (P < 0.0006). TG was greater in OBZ tongue (3.57 ± 1.7 mg/g) than OBZ masseter muscle (0.28 ± 0.1; P < 0.0001) but tongue and masseter TG were not different in NBZ rats (0.82 ± 0.3 versus 0.28 ± 0.1 mg/g, P = 0.67). Dixon fat volume was significantly increased in OBZ (56 ± 15 mm3) versus NBZ (34 ± 5 mm3, P < 0.004). Histology demonstrated a greater degree of intracellular muscle fat and extramuscular fat infiltration in OBZ versus NBZ rats. CONCLUSIONS Genetically obese rats had a large degree of fat infiltration in the tongue compared to both skeletal muscle and tongue tissues of the non-obese age-matched littermates. The significant fat increase and sequestration in the obese tongue may play a role in altered tongue neuromuscular function, tongue stiffness or metabolic function.
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Affiliation(s)
| | | | - Allan I. Pack
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine
| | | | | | | | | | | | - Laurence U. Buxbaum
- Philadephia Research and Education Foundation, Philadelphia, PA
- Division of Infectious Disease, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Richard J. Schwab
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine
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Amatoury J, Kairaitis K, Wheatley JR, Bilston LE, Amis TC. Peripharyngeal tissue deformation and stress distributions in response to caudal tracheal displacement: pivotal influence of the hyoid bone? J Appl Physiol (1985) 2014; 116:746-56. [DOI: 10.1152/japplphysiol.01245.2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Caudal tracheal displacement (TD) leads to improvements in upper airway (UA) function and decreased collapsibility. To better understand the mechanisms underlying these changes, we examined effects of TD on peripharyngeal tissue stress distributions [i.e., extraluminal tissue pressure (ETP)], deformation of its topographical surface (UA lumen geometry), and hyoid bone position. We studied 13 supine, anesthetized, tracheostomized, spontaneously breathing, adult male New Zealand white rabbits. Graded TD was applied to the cranial tracheal segment from 0 to ∼10 mm. ETP was measured at six locations distributed around/along the length of the UA, covering three regions: tongue, hyoid, and epiglottis. Axial images of the UA (nasal choanae to glottis) were acquired with computed tomography and used to measure lumen geometry (UA length; regional cross-sectional area) and hyoid bone displacement. TD resulted in nonuniform decreases in ETP (generally greatest at tongue region), ranging from −0.07 (−0.11 to −0.03) [linear mixed-effects model slope (95% confidence interval)] to −0.27 (−0.31 to −0.23) cmH2O/mm TD, across all sites. UA length increased by 1.6 (1.5–1.8)%/mm, accompanied by nonuniform increases in cross-sectional area (greatest at hyoid region) ranging from 2.8 (1.7–3.9) to 4.9 (3.8–6.0)%/mm. The hyoid bone was displaced caudally by 0.22 (0.18–0.25) mm/mm TD. In summary, TD imposes a load on the UA that results in heterogeneous changes in peripharyngeal tissue stress distributions and resultant lumen geometry. The hyoid bone may play a pivotal role in redistributing applied caudal tracheal loads, thus modifying tissue deformation distributions and determining resultant UA geometry outcomes.
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Affiliation(s)
- Jason Amatoury
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia; and
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Kristina Kairaitis
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia; and
| | - John R. Wheatley
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia; and
| | - Lynne E. Bilston
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Terence C. Amis
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia; and
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