title: Dynamic interaction between the tongue and soft palate during obstructive apnea in anesthetized patients with sleep-disordered breathing.
abstract: Little is known about the mechanisms of persistence of obstructive apnea. Structurally, the dorsum of the tongue locates anterior to the soft palate. On the basis of the observation of posterior displacement of the tongue during obstructive apnea, we hypothesized that the dorsum of the tongue pushes the anterior wall of the soft palate posteriorly during inspiratory efforts, maintaining closure at the retropalatal airway. To test this hypothesis, we measured the pressure between dorsum of the tongue and anterior wall of the soft palate (PT&P) during experimentally induced obstructive apneas in anesthetized patients with sleep-disordered breathing. P(T&P) changes during the obstruction significantly depended on collapsibility of the retroglossal airway. Progressive increase in the P(T&P) during obstructive apnea was observed only in patients with highly collapsible retroglossal airways. Significant increase in the P(T&P) during inspiratory effort in accordance with positive deflection pattern of P(T&P) tracing was evident in the patients with highly collapsible retroglossal airways. The results indicate significant dynamic interaction between the tongue and soft palate during both obstructive apnea and each inspiratory effort, possibly maintaining closure at the retropalatal airway.
authors.affiliation: Department of Anesthesiology (B1 Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. isonos-chiba@umin.ac.jp
authors.forename: Shiroh
authors.initials: S
authors.lastname: Isono
authors.forename: Atsuko
authors.initials: A
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishino
mesh_terms: D000328:Adult; D000758:Anesthesia; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010160:Palate, Soft / Q000503:physiopathology* / Q000601:surgery; D010614:Pharynx / Q000503:physiopathology / Q000601:surgery; D011312:Pressure; D015656:Respiratory Mechanics / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000601:surgery; D012893:Sleep Wake Disorders / Q000503:physiopathology*; D014059:Tongue / Q000503:physiopathology*; D014609:Uvula / Q000503:physiopathology / Q000601:surgery