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Analysis of the myoelectric characteristics of genioglossus in REM sleep and its improvement by CPAP treatment in OSA patients



To reveal the characteristics of genioglossus (GG) activation in moderate and severe obstructive sleep apnea (OSA) patients during rapid eye movement (REM) sleep compared with non-rapid eye movement (NREM) sleep and to determine whether continuous positive airway pressure (CPAP) could improve GG activation in OSA patients during sleep.


All subjects underwent polysomnography (PSG) with synchronous GG electromyography (GGEMG) recording with intra-oral surface electrodes at baseline on the first night. Only those subjects diagnosed with moderate and severe OSA were included and were manually titrated with CPAP to achieve a therapeutic pressure (Pt) with GGEMG recording on the second night.


Nine OSA patients and six normal controls were analyzed in this study. The tonic GGEMG was higher in OSA patients during wakefulness (p = 0.003) and NREM sleep (p = 0.015), but it was not higher in REM sleep (p = 0.862). The average phasic activity of OSA patients was significantly higher in all stages, including wakefulness (p = 0.007), NREM sleep (p = 0.005), and REM sleep (p = 0.021). The peak phasic GGEMG was not different in wakefulness compared with normal controls (p = 0.240), but it was higher in OSA patients in NREM sleep (p = 0.001) and REM sleep (p = 0.021), and it was significantly reduced by using CPAP during sleep (NREM sleep: p = 0.027; REM sleep: p = 0.001).


Our results demonstrate that GG activation during NREM and REM sleep is associated with component differences. The tonic component of GGEMG exhibited less of a compensatory increase compared with the phasic component in REM sleep, suggesting that it may be one of the pathological mechanisms of UA collapsibility in REM sleep. In addition, treatment with CPAP can normalize GGEMG activity and mostly reduced the peak phasic GGEMG during sleep.

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genioglossus electromyography


rapid eye movement


non-rapid eye movement


obstructive sleep apnea


continuous positive airway pressure


therapeutic pressure




upper airway


apnea-hypopnea index


body mass index








American Academy of Sleep Medicine


root mean square


lowest oxygen saturation


mean oxygen saturation during sleep


oxygen desaturation index of ≥ 3%


arousal index


respiratory effort–related arousals


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The authors are grateful for the technical support provided by staff in the Department of Otolaryngology, Beijing Tsinghua Chang Gung Hospital, and to Prof. Hong Xu for fruitful discussions.


This work was supported by the National Natural Science Foundation of China [grant number 81670918, 81873696] and Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (XMLX201703).

Author information

Prof. Jingying Ye, Di Zhao, Guoping Yin and Yuhuan Zhang contributed to the experimental design and interpretation of the results. Jingjing Li and Xin Cao collected and analyzed the data. Yingqian Zhou contributed to data analysis and interpretation and wrote the manuscript. All authors contributed to the final version.

Correspondence to Jingying Ye.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study was approved by the Beijing Tsinghua Chang Gung Hospital Institutional Review Board.

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Zhou, Y., Zhao, D., Yin, G. et al. Analysis of the myoelectric characteristics of genioglossus in REM sleep and its improvement by CPAP treatment in OSA patients. Sleep Breath (2019).

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  • Obstructive sleep apnea
  • Genioglossus
  • Intra-oral surface electrode
  • Neuromuscular lesions
  • Continuous positive airway pressure