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Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients
Open accessAbstract
The purpose of the present study was to quantify the mechanical effect of genioglossus stimulation on flow mechanics and pharyngeal cross-sectional area in patients with obstructive sleep apnoea, and to identify variables that determine the magnitude of the respiratory effect of tongue protrusion. The pressure/flow and pressure/cross-sectional area relationships of the velo- and oropharynx were assessed in spontaneously breathing propofol-anaesthetised subjects before and during genioglossus stimulation. Genioglossus contraction decreased the critical pressure significantly from 1.2±3.3 to -0.7±3.8 cmH 2 O, with individual decreases ranging -0.6–5.9 cmH 2 O. Pharyngeal compliance was not affected by genioglossus contraction. The pharyngeal response to genioglossus stimulation was related to the magnitude of advancement of the posterior side of the tongue, but not to the severity of sleep apnoea, critical pressure, compliance or the shape and other characteristics of the velopharynx. Genioglossus contraction enlarges both the velo- and the oropharynx and lowers the critical pressure without affecting pharyngeal stiffness. The response to genioglossus stimulation depends upon the magnitude of tongue protrusion achieved rather than on inherent characteristics of the patient and their airway.
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Prior studies have shown a graded increase in airflow and multilevel airway measurements with increasing stimulation amplitudes until a plateau, balancing patient discomfort with therapeutic efficacy.
“Prior studies have shown a graded increase in airflow and multilevel airway measurements with increasing stimulation amplitudes until a plateau is reached, balancing patient discomfort with therapeutic efficacy.1901–1905”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1904]
The Results report increased airflow during genioglossus stimulation in some patients and increased airway cross-sectional area at the oropharynx and velopharynx. The Anaesthesia section says stimulation intensity was selected for the best dilatory response and limited to levels tolerated during wakefulness. It does not report a graded increase with rising stimulation amplitude or an amplitude-related plateau; the plateau described in Data analysis concerns airflow during falling oesophageal pressure, not stimulation amplitude. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOther groups failed to find an enlargement of the upper airways by transcutaneous or intramuscular stimulation during wakefulness or sleep; undesirable contractions of the platysma or tongue were observed and arousals were induced.
“In contrast, other groups failed to find an enlargement of the upper airways by transcutaneous or intramuscular stimulation during wakefulness or sleep. However, undesirable contractions of the platysma or tongue were observed and arousals were induced 114, 116, 120, 121.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [116]
The Discussion (page unavailable) reports that some earlier stimulation attempts were unsuccessful or produced inconsistent clinical results. It also reports mechanical improvements in earlier work and pharyngeal enlargement in the present study, so it does not support a blanket claim that stimulation failed to enlarge the airway. The passages found do not report platysma or unwanted tongue contractions or stimulation-induced arousals. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe patency of the upper airways depends more on the effective stimulation of the genioglossus muscles.
“Oliven and co-workers 115, 116 studied the critical pharyngeal pressure under intraneural hypoglossus and intramuscular and surface genioglossus stimulation and demonstrated that the patency of the upper airways depends more on the effective stimulation of the genioglossus muscles.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [116]
The Discussion reports that effective genioglossus stimulation, particularly stimulation that advances the back of the tongue, can enlarge the pharynx and reduce critical pressure. But it says the muscle is only one of several involved in maintaining patency and that adequate stimulation alone may be insufficient in patients with very high critical pressure. The claim overstates this conditional finding as a general dependence. (LLM, conf=0.84)
Experimental — accuracy not yet measuredStimulation of the genioglossus muscle most effectively reduces resistance and the critical pressure Pcrit.
“The stimulation of the genioglossus muscle most effectively reduces resistance and the critical pressure Pcrit 113, 115, 116.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [116]
The opening section reports that genioglossus activation reduced pharyngeal resistance more than other upper-airway dilators in animal studies. The Abstract reports that stimulation lowered Pcrit in patients with obstructive sleep apnoea, but the paper does not establish that it lowered Pcrit more effectively than stimulation of other muscles. (LLM, conf=0.83)
Experimental — accuracy not yet measuredStimulation of the upper airway muscles with surface and intraneural electrodes has proven to reduce the resistance of the upper airways both in healthy persons and patients with obstructive sleep apnoea syndrome.
“Stimulation of the upper airway muscles with surface and intraneural electrodes has proven to reduce the resistance of the upper airways both in healthy persons and patients with OSAS 27, 112–118.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [116]
The Discussion reports that electrical stimulation improved pharyngeal airflow and patency in the studied sleep-apnoea patients, and describes mechanical improvements with surface electrodes in earlier work. It does not establish reduced airway resistance with both surface and intraneural electrodes in both healthy people and patients; this study used inserted hookwire electrodes and studied patients, not healthy controls. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Genioglossus contraction enlarges both the velo- and the oropharynx and lowers the critical pressure without affecting the stiffness.
“Genioglossus contraction enlarges both the velo- and the oropharynx and lowers the critical pressure without affecting the stiffness 116.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [116]
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References 35 · Cited by 85
Metadata
- Authors
- Oliven, A., Tov, N., Geitini, L., Steinfeld, U., Oliven, R., Schwartz, A. R., & Odeh, M.
- Affiliations
- Technion – Israel Institute of Technology (IL)
- Johns Hopkins University (US)
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2007-06-13
- Volume
- 30
- Issue
- 4
- Pages
- 748-758
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W2110386263
- Semantic Scholar
- 46623c46f13dfccf644696bdefbabb769fc86f2a
- Cited by
- 85
- References
- 35
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 5 · 2012: 9
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (HL37379, R01HL037379, HL50381)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- obstructive sleep apnea, air flow, tongue protrusion, critical pressure, velopharynx, oropharynx, airway mechanics, propofol anesthesia
- MeSH terms
- Adult, Electroencephalography, Electrooculography, Electric Stimulation Therapy, Humans, Hypoglossal Nerve, Male, Middle Aged, Models, Anatomic, Muscles, Oxygen, Pharyngeal Muscles, Pharynx, Pressure, Tongue, Polysomnography, Sleep Apnea, Obstructive
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