The Pharyngeal Critical Pressure
Year: 1996
Type: review
Abstract: apnea/hypopnea index continuous positive airway pressure nonrapid eye movement critical pressure pressure downstream to the collapsible segment esophageal pressure pressure within the segment nasal mask pressure pressure outside collapsible segment pressure upstream to the collapsible segment resistance of portion of tube upstream to site of collapse upper airway resistance syndrome uvulopalatopharyngoplasty maximal inspiratory flow maximal flow Obstructive sleep apnea is a disorder characterized by pharyngeal collapse and occlusion during sleep. The disorder affects between 2% and 5% of the middle-aged population1Young T Palta M Dempsey J et al.Occurrence of sleep disordered breathing among middle-aged adults.N Engl J Med. 1993; 328: 1230-1235Crossref PubMed Scopus (8337) Google Scholar and is associated with significant morbidity and mortality.2Guilleminault C Stoohs R Partinen M et al.Mortality and morbidity of obstructive sleep apnea syndrome: prospective studies on retrospective cohorts.in: Saunders NA Sullivan CE 2nd ed. Sleep and breathing. Marcel Dekker, New York1994: 557-574Google Scholar The mechanism responsible for pharyngeal collapse during sleep remains uncertain. Investigators have identified both anatomic factors3Haponik EF Smith PL Bohlman ME et al.Computerized tomography in obstructive sleep apnea: correlation of airway size with physiology during sleep and wakefulness.Am Rev Respir Dis. 1983; 127: 221-226PubMed Google Scholar, 4Bradley TD Brown IG Grossman RF et al.Pharyngeal size of snorers, non-snorers, and patients with obstructive sleep apnea.N Engl J Med. 1986; 315: 1327-1331Crossref PubMed Scopus (233) Google Scholar, 5Schwab RJ Gefter WB Hoffman EA et al.Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing.Am Rev Respir Dis. 1993; 148: 1385-1400Crossref PubMed Scopus (406) Google Scholar, 6Shelton KE Woodson H Gay S et al.Pharyngeal fat in obstructive sleep apnea.Am Rev Respir Dis. 1993; 148: 462-466Crossref PubMed Scopus (354) Google Scholar and neuromuscular control factors7Remmers JE DeGroot WJ Sauerland EK et al.Pathogenesis of upper airway occlusion during sleep.J Appl Physiol. 1978; 44: 931-938Crossref PubMed Scopus (1396) Google Scholar, 8Anch AM Remmers JE Sauerland EK et al.Oropharyngeal patency during waking and sleep in the pickwickian syndrome: electromyographic activity of the tensor veli palatini.Electromyogr Clin Neurophysiol. 1981; 21: 317-330PubMed Google Scholar, 9Jeffries B Brouillette RT Hunt CE. Electromyographic study of some accessory muscles of respiration in children with obstructive sleep apnea.Am Rev Respir Dis. 1984; 129: 696-702Crossref PubMed Scopus (54) Google Scholar, 10Suratt PM McTier R Wilhoit SC. Alae nasi electromyographic activity and timing in obstructive sleep apnea.J Appl Physiol. 1985; 58: 1252-1256Crossref PubMed Scopus (19) Google Scholar that may lead to increased pharyngeal collapsibility during sleep in patients with obstructive sleep apnea.Although our understanding of the factors responsible for pharyngeal collapse during sleep is limited, treatments have been developed to oppose pharyngeal collapse during sleep in patients with obstructive sleep apnea. One such treatment, nasal continuous positive airway pressure (nasal CPAP), is often prescribed to offset the increase in pharyngeal collapsibility during sleep.11Sullivan CE Issa FG Berthon-Jones M et al.Reversal of obstructive sleep apnoea by continuous positive pressure applied through the nares.Lancet. 1981; 1: 862-865Abstract PubMed Scopus (2024) Google Scholar,12Sullivan CE Issa FG Berthon-Jones M et al.Home treatment of obstructive sleep apnoea with continuous positive pressure applied through a nose-mask.Bull Eur Physiopathol Respir. 1984; 20: 49-54PubMed Google Scholar When an appropriate level of nasal CPAP is prescribed, this treatment is highly effective the during sleep of the mechanism for pharyngeal with nasal is to of patients nasal CPAP and treatment Saunders of continuous positive airway pressure in obstructive sleep apnea.Am Rev Respir Dis. PubMed Scopus Google Scholar, et of of nasal CPAP by patients with obstructive sleep apnea.Am Rev Respir Dis. 1993; PubMed Scopus Google Scholar, R an of J Respir Med. PubMed Scopus Google Scholar effective treatments for obstructive sleep apnea to nasal CPAP in patients treatments to the of obstructive sleep apnea. treatments the The of on sleep disordered breathing and in PubMed Scopus Google Scholar, PL et in patients with obstructive sleep Med. 1985; PubMed Scopus (354) Google Scholar, PM McTier ME et in breathing and the in obstructive sleep PubMed Scopus Google Scholar et in obstructive sleep apnea: a Engl J Med. PubMed Scopus Google PL EF et of in sleep disordered breathing.Am Rev Dis. 1983; 127: PubMed Scopus Google Scholar S et of upper airway in obstructive sleep apnea syndrome: 1981; PubMed Scopus Google Scholar, C and some obstructive sleep apnea by 1983; PubMed Scopus Google Scholar, for obstructive sleep apnea and Scopus Google Scholar R The of a treatment for obstructive sleep apnea: the PubMed Scopus Google to the for sleep apnea 1985; PubMed Scopus Google Scholar et of on obstructive sleep apnea.Am Rev Respir Dis. 1993; PubMed Scopus Google et of a in obstructive sleep apnea.Am J Respir Med. PubMed Scopus Google Scholar and R and obstructive sleep apnea: a of PubMed Scopus Google Scholar and of the pharyngeal H T et of during sleep on upper airway patency in patients with obstructive sleep apnea.Am Rev Respir Dis. PubMed Scopus Google T et in obstructive sleep apnea Rev Respir Dis. 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The of the obstructive is associated with the of inspiratory Sullivan CE. of sleep Saunders NA Sullivan CE 2nd ed. Sleep and breathing. 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PubMed Scopus Google Scholar and C Stoohs R et obstructive sleep apnea syndrome to upper airway resistance syndrome: of Google Scholar have the upper airway resistance syndrome The of both and obstructive sleep patients patients with inspiratory flow during sleep patients with obstructive sleep patients with sleep and that with nasal CPAP inspiratory is in the a that of patients a level of to patients with obstructive that the of for patients with is to between that of and that of patients with the sleep the in patients with been to our understanding of the of pharyngeal collapsibility to and for Obstructive Sleep the of the pharyngeal airway a collapsible normal have a of between and pharyngeal the between and with inspiratory flow and obstructive and obstructive apnea. that and of inspiratory to normal in obstructive sleep a pressure of between and pharyngeal is effective of obstructive sleep apnea that a to the site of pharyngeal collapse of the normal pressure between and pharyngeal by of increased to a level of nasal in and between and nasal between and of pharyngeal airway H of continuous positive airway pressure level for treatment of obstructive sleep apnea.Am Rev Respir Dis. 1993; PubMed Google of obstructive sleep apnea: an T and of sleep WB Scholar the between and by the to the sleep of obstructive sleep apnea with treatments that to and to with treatments that to of the of uvulopalatopharyngoplasty and on the that a in the of obstructive sleep apnea a in et of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. PubMed Scopus Google et of on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. PubMed Google and et of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. PubMed Scopus Google Scholar the between and the to is a to pharyngeal during sleep by the of the level of the and S et of upper airway in obstructive sleep apnea syndrome: 1981; PubMed Scopus Google Scholar, C and some obstructive sleep apnea by 1983; PubMed Scopus Google Scholar, for obstructive sleep apnea and Scopus Google Scholar been that the of pharyngeal to is some patients a in the of disordered breathing by the a to is on a in pharyngeal the and of patients for obstructive sleep apnea the to with a in of patients that to by and patients a of of patients pharyngeal to to a normal significant in patients to a in pharyngeal collapsibility a in The study the that an effective treatment for obstructive and apnea the to the level patients with obstructive with the between the disordered breathing with and for patients and for in and in in to in of sleep disordered with et of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. PubMed Scopus Google the of on pharyngeal collapsibility our to for the treatment of obstructive sleep apnea. is to the in obstructive sleep apnea The of on sleep disordered breathing and in PubMed Scopus Google Scholar, PL et in patients with obstructive sleep Med. 1985; PubMed Scopus (354) Google Scholar, PM McTier ME et in breathing and the in obstructive sleep PubMed Scopus Google Scholar patients with to obstructive sleep Smith and PL et in patients with obstructive sleep Med. 1985; PubMed Scopus (354) Google Scholar a in the sleep a in to patients disordered breathing is often to and the have a treatment for obstructive sleep the among airway and the of disordered breathing and et of on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. PubMed Google Scholar the of on the pharyngeal of patients with to obstructive sleep apnea. that a in and that the in with the of the of patients a of by patients in that affects obstructive sleep apnea by the collapsibility of the pharyngeal airway in to the of the between the in by and the in for patients with obstructive sleep a correlation between the of and the in The with et of on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. PubMed Google the collapsibility of the pharyngeal is the of the to The the between and patients with the in with of pharyngeal that with of that is that the pharyngeal and the of the to in patients with obstructive sleep the between breathing with and in a of and patients with obstructive sleep and for is in to in of with et of on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. PubMed Google the study of and et of on upper airway collapsibility in obstructive sleep apnea.Am Rev Respir Dis. 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Obstructive sleep apnea is a disorder characterized by pharyngeal collapse and occlusion during sleep. The disorder affects between 2% and 5% of the middle-aged population1Young T Palta M Dempsey J et al.Occurrence of sleep disordered breathing among middle-aged adults.N Engl J Med. 1993; 328: 1230-1235Crossref PubMed Scopus (8337) Google Scholar and is associated with significant morbidity and mortality.2Guilleminault C Stoohs R Partinen M et al.Mortality and morbidity of obstructive sleep apnea syndrome: prospective studies on retrospective cohorts.in: Saunders NA Sullivan CE 2nd ed. Sleep and breathing. Marcel Dekker, New York1994: 557-574Google Scholar The mechanism responsible for pharyngeal collapse during sleep remains uncertain. Investigators have identified both anatomic factors3Haponik EF Smith PL Bohlman ME et al.Computerized tomography in obstructive sleep apnea: correlation of airway size with physiology during sleep and wakefulness.Am Rev Respir Dis. 1983; 127: 221-226PubMed Google Scholar, 4Bradley TD Brown IG Grossman RF et al.Pharyngeal size of snorers, non-snorers, and patients with obstructive sleep apnea.N Engl J Med. 1986; 315: 1327-1331Crossref PubMed Scopus (233) Google Scholar, 5Schwab RJ Gefter WB Hoffman EA et al.Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing.Am Rev Respir Dis. 1993; 148: 1385-1400Crossref PubMed Scopus (406) Google Scholar, 6Shelton KE Woodson H Gay S et al.Pharyngeal fat in obstructive sleep apnea.Am Rev Respir Dis. 1993; 148: 462-466Crossref PubMed Scopus (354) Google Scholar and neuromuscular control factors7Remmers JE DeGroot WJ Sauerland EK et al.Pathogenesis of upper airway occlusion during sleep.J Appl Physiol. 1978; 44: 931-938Crossref PubMed Scopus (1396) Google Scholar, 8Anch AM Remmers JE Sauerland EK et al.Oropharyngeal patency during waking and sleep in the pickwickian syndrome: electromyographic activity of the tensor veli palatini.Electromyogr Clin Neurophysiol. 1981; 21: 317-330PubMed Google Scholar, 9Jeffries B Brouillette RT Hunt CE. Electromyographic study of some accessory muscles of respiration in children with obstructive sleep apnea.Am Rev Respir Dis. 1984; 129: 696-702Crossref PubMed Scopus (54) Google Scholar, 10Suratt PM McTier R Wilhoit SC. Alae nasi electromyographic activity and timing in obstructive sleep apnea.J Appl Physiol. 1985; 58: 1252-1256Crossref PubMed Scopus (19) Google Scholar that may lead to increased pharyngeal collapsibility during sleep in patients with obstructive sleep apnea. our understanding of the factors responsible for pharyngeal collapse during sleep is limited, treatments have been developed to oppose pharyngeal collapse during sleep in patients with obstructive sleep apnea. One such treatment, nasal continuous positive airway pressure (nasal CPAP), is often prescribed to offset the increase in pharyngeal collapsibility during sleep.11Sullivan CE Issa FG Berthon-Jones M et al.Reversal of obstructive sleep apnoea by continuous positive pressure applied through the nares.Lancet. 1981; 1: 862-865Abstract PubMed Scopus (2024) Google Scholar,12Sullivan CE Issa FG Berthon-Jones M et al.Home treatment of obstructive sleep apnoea with continuous positive pressure applied through a nose-mask.Bull Eur Physiopathol Respir. 1984; 20: 49-54PubMed Google Scholar When an appropriate level of nasal CPAP is prescribed, this treatment is highly effective the during sleep of the mechanism for pharyngeal with nasal is to of patients nasal CPAP and treatment Saunders of continuous positive airway pressure in obstructive sleep apnea.Am Rev Respir Dis. PubMed Scopus Google Scholar, et of of nasal CPAP by patients with obstructive sleep apnea.Am Rev Respir Dis. 1993; PubMed Scopus Google Scholar, R an of J Respir Med. PubMed Scopus Google Scholar effective treatments for obstructive sleep apnea to nasal CPAP in patients treatments to the of obstructive sleep apnea. treatments the The of on sleep disordered breathing and in PubMed Scopus Google Scholar, PL et in patients with obstructive sleep Med. 1985; PubMed Scopus (354) Google Scholar, PM McTier ME et in breathing and the in obstructive sleep PubMed Scopus Google Scholar et in obstructive sleep apnea: a Engl J Med. PubMed Scopus Google PL EF et of in sleep disordered breathing.Am Rev Dis. 1983; 127: PubMed Scopus Google Scholar S et of upper airway in obstructive sleep apnea syndrome: 1981; PubMed Scopus Google Scholar, C and some obstructive sleep apnea by 1983; PubMed Scopus Google Scholar, for obstructive sleep apnea and Scopus Google Scholar R The of a treatment for obstructive sleep apnea: the PubMed Scopus Google to the for sleep apnea 1985; PubMed Scopus Google Scholar et of on obstructive sleep apnea.Am Rev Respir Dis. 1993; PubMed Scopus Google et of a in obstructive sleep apnea.Am J Respir Med. PubMed Scopus Google Scholar and R and obstructive sleep apnea: a of PubMed Scopus Google Scholar and of the pharyngeal H T et of during sleep on upper airway patency in patients with obstructive sleep apnea.Am Rev Respir Dis. PubMed Scopus Google T et in obstructive sleep apnea Rev Respir Dis. Scholar of treatments an increase in pharyngeal collapsibility during of treatments is effective in the of nasal often to the of a treatment on the of obstructive sleep apnea in a The of a for the of a treatment on the of obstructive sleep apnea in a the the to nasal the in treatment for obstructive sleep the between obstructive sleep apnea and pharyngeal that pharyngeal collapsibility a to of is to pharyngeal collapsibility to to associated with normal breathing during sleep. to a for sleep apnea on both the to pharyngeal collapsibility is in a and the by is with a a for pharyngeal collapsibility the pharyngeal collapsibility of with of pharyngeal airway during sleep and the between in pharyngeal collapsibility and in the of obstructive sleep apnea this a to obstructive sleep apnea by pharyngeal collapsibility the to in our and to for pharyngeal collapsibility in a sleep nasal The study of pharyngeal collapsibility in obstructive sleep apnea on of collapsible and in collapse of the The collapse in the of the flow of through collapsible J Physiol. Scholar collapse of on S et of maximal flow the Appl Physiol. PubMed Scopus Google J et
Source: CHEST Journal
Authors: Avram R. Gold, Alan R. Schwartz
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,160
OpenAlex ID: W2034657656