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Published ahead of print on June 1, 2004, doi:10.1164/rccm.200403-262OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 5, September 2004, 553-560

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Submitted on March 2, 2004
Accepted on May 31, 2004

Genioglossus Activity During Sleep in Normal Controls and Children with Obstructive Sleep Apnea

Eliot S Katz1* and David P White2

1 Division of Respiratory Diseases, Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 2 Department of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed. E-mail: eliot.katz{at}childrens.harvard.edu.

Children with the obstructive sleep apnea syndrome (OSAS) have more collapsible airways compared to normal subjects, yet sustain stable breathing during wakefulness and part of sleep. This indicates successful neuromuscular compensation. Using a custom intra-oral 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) OSAS patients without CPAP (N = 13); (2) OSAS patients 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 to 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 OSAS patients, 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 OSAS patients 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. (3) REM sleep is associated with the lowest and most variable EMGgg.
Key words: Intra-oral surface electrode, genioglossus EMG, REM sleep




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