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Anatomy and Function of Upper Airway During Sleep: What Are Essential Mechanisms Eliciting Apneas During Sleep?

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Structure-Function Relationships in Various Respiratory Systems

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Abstract

During sleep, both the tonic and inspiratory-modulated components of upper airway muscle activity are suppressed in parallel with the characteristic postural atonia. In individuals with a constricted upper airway related to anatomical factors such as a large tongue relative to maxilla and mandible (i.e., oropharyngeal crowding), this sleep-related reduction in upper airway muscle activity could precipitate an upper airway occlusion more easily and lead to obstructive sleep apnea. However, in the narrowed upper airway of patients with obstructive sleep apnea, a neuromuscular compensatory mechanism augments the activity of the upper airway dilator muscles in defense of upper airway patency, particularly during inspiration. When the crowded oropharynx is improved by the application of positive airway pressure and/or mandibular advancement, upper airway dilator muscle activity during inspiration is reduced, returning the upper airway toward a normal configuration and pattern of muscle function in patients with obstructive sleep apnea. Accordingly, the upper airway patency in humans is precisely controlled by the close anatomical–functional relationship.

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Acknowledgments

Research discussed in this chapter was in part supported by grants from the Japanese Society for the Promotion of Science (Grant-in-Aid for Scientific Research; 17K11793, 19K10236, 20K10085).

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Authors and Affiliations

  1. Institute of Neuropsychiatry, Shibuya-ku, Tokyo, Japan

    Satoru Tsuiki

  2. Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan

    Satoru Tsuiki

  3. Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada

    Satoru Tsuiki

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  1. Satoru Tsuiki
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Correspondence to Satoru Tsuiki .

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Editors and Affiliations

  1. Department of Respiratory Medicine, Tokyo Medical University, Division of Respiratory Medicine, Tohto Clinic, Kenko-Igaku Association, Tokyo, Japan

    Kazuhiro Yamaguchi

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Tsuiki, S. (2020). Anatomy and Function of Upper Airway During Sleep: What Are Essential Mechanisms Eliciting Apneas During Sleep?. In: Yamaguchi, K. (eds) Structure-Function Relationships in Various Respiratory Systems. Respiratory Disease Series: Diagnostic Tools and Disease Managements. Springer, Singapore. https://doi.org/10.1007/978-981-15-5596-1_4

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  • DOI: https://doi.org/10.1007/978-981-15-5596-1_4

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  • Publisher Name: Springer, Singapore

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  • Online ISBN: 978-981-15-5596-1

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