Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism).
Open accessAbstract
Pharyngeal collapse in obstructive sleep apnea patients is likely a product of a sleep-related decrement in pharyngeal dilator muscle activity superimposed upon abnormal airway anatomy. We postulate that during wakefulness, increased pharyngeal dilator muscle activity in apnea patients compensates for diminished airway size thus maintaining patency. We studied the waking genioglossus (GG) electromyogram (EMG) activity in 11 OSA patients and 14 age-matched controls to determine if GG activity is higher in the awake state in apnea patients than controls. To make this determination, we developed a reproducible methodology whereby true maximal GG EMG could be defined and thus basal activity quantitated as a percentage of this maximal value. Therefore, direct comparisons of basal activity between individuals was possible. We observed apnea patients to have significantly greater basal genioglossal activity compared to controls (40.6 +/- 5.6% vs. 12.7 +/- 1.7% of maximum). This difference persisted when size-matched subsets were compared. This augmented GG activity in apnea patients could be reduced with positive airway pressure. We speculate that this neuromuscular compensation present during wakefulness in apnea patients may be lost during sleep leading to airway collapse.
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Obesity, specifically central adiposity, increases pharyngeal collapsibility that causes recurrent episodes of upper airway obstruction in sleep apnea through mechanical and neuromuscular effects.
“Obesity, specifically central adiposity, increases pharyngeal collapsibility that causes recurrent episodes of UA obstruction in sleep apnea through both mechanical and neuromuscular effects.199–203”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [201]
The Introduction and Discussion (page not specified) describe pharyngeal collapse in sleep apnea as involving airway anatomy and dilator-muscle activity, supporting the mechanical and neuromuscular portion of the claim. The Methods compare patients with obese, size-matched controls, but the paper does not establish that obesity—specifically central adiposity—increases collapsibility or causes recurrent obstruction. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThrough protective upper airway dilator muscle reflexes, muscle activity is increased during wakefulness in OSA compared to matched controls.
“Through protective UA dilator muscle reflexes, the activity of the muscles is increased during wakefulness in OSA compared to matched controls.201”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [201]
The Abstract reports significantly greater waking genioglossus activity in OSA patients than in age-matched controls, with the difference persisting in size-matched subsets. The Introduction and later discussion propose a protective reflex response to negative airway pressure, but describe that mechanism as theoretical or speculative rather than established; the study measured the genioglossus, not upper-airway dilator muscles generally. No page number is provided for these passages. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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- Authors
- Mezzanotte, W. S., Tangel, D. J., & White, D. P.
- Affiliations
- Denver VA Medical Center (US)
- National Jewish Health (US)
- Venue
- Journal of Clinical Investigation
- Published
- 1992-05-01
- Volume
- 89
- Issue
- 5
- Pages
- 1571-1579
- ISSN
- 0021-9738 (ISSN-L)
- PMC
- PMC443031
- OpenAlex
- W2139404323
- Cited by
- 769
- References
- 56
- Citations by year
- 2026: 18 · 2025: 9 · 2024: 25 · 2023: 23 · 2022: 18 · 2021: 14 · 2020: 23 · 2019: 32 · 2018: 33 · 2017: 23 · 2016: 21 · 2015: 30 · 2014: 44 · 2013: 22 · 2012: 26
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL-07085, T32HL007085)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- obstructive sleep apnea, genioglossus muscle, pharyngeal dilator muscles, neuromuscular compensation, pharyngeal collapse, airway patency, positive airway pressure, wakefulness
- MeSH terms
- Electromyography, Humans, Male, Pharynx, Sleep Apnea Syndromes, Wakefulness
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