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Genioglossus Activity During Sleep in Normal Control Subjects and Children with Obstructive Sleep Apnea

Division of Respiratory Diseases, Department of Medicine, Children's Hospital; and Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to Eliot S. Katz, M.D., Division of Respiratory Diseases, Mailstop 208, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail: eliot.katz{at}childrens.harvard.edu

Children with obstructive sleep apnea syndrome (OSAS) have more collapsible airways compared with normal subjects, yet sustain stable breathing during wakefulness and part of sleep. This indicates successful neuromuscular compensation. Using a custom intraoral surface electrode to record pharyngeal dilator muscle activity (the genioglossus [EMGgg] normalized to the wakeful baseline), we performed overnight polysomnograms in three groups of children: (1) patients with OSAS without continuous positive airway pressure (CPAP) (n = 13); (2) patients with OSAS with CPAP (n = 5); and (3) control subjects without CPAP (n = 13). Our objective was to evaluate the EMGgg as a function of sleep state and during disordered breathing, compared with stable sleep and wakefulness. In control subjects, the EMGgg decreased from wakefulness to Stage 2 (mean ± SD, 65 ± 6%), and further during REM (51 ± 9%) (p < 0.05). In patients with OSAS, the EMGgg for apneic breaths during REM (37 ± 9%) was lower than during stable breathing (83 ± 17%) (p < 0.05) and wakefulness (p < 0.05). CPAP lowered the EMGgg in patients with OSAS during all sleep states. These data indicate that (1) EMGgg compensatory mechanisms remain active during sleep in patients with severe OSAS; (2) EMGgg reductions are temporally associated with sleep apnea events; and (3) REM sleep is associated with the lowest and most variable EMGgg.

Key Words: genioglossus EMG • intraoral surface electrode • REM sleep

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