Obstructive Sleep Apnea, Pathophysiology
Conditions
Keywords
Obstructive Sleep Apnea, Pathophysiology
Brief summary
In obstructive sleep apnea, the upper airway recurrently closes during sleep. The mechanisms that lead to airway closure are not completely understood. While the airway of some people narrows and airflow decreases during inspiration due to increasing inspiratory effort, others maintain constant airflow throughout inspiration. Airway neuromuscular reflexes may protect against airway narrowing that occurs due to increasing inspiratory effort. To test this hypothesis, the investigators will initially measure airway neuromuscular reflex and inspiratory flow and then attenuate neuromuscular reflex through topical pharyngeal anesthesia to observe the effects on inspiratory flow.
Detailed description
The mechanisms that lead to airway closure are not completely understood. While the airway of some people narrows and airflow decreases during inspiration due to increasing inspiratory effort, others maintain constant airflow throughout inspiration (negative effort dependence, NED). The investigators hypothesize that upper airway neuromuscular reflexes may protect against narrowing that occurs due to increasing inspiratory effort. Topical oropharyngeal anesthesia has been shown to reduce neuromuscular reflexes. Thus, the investigators also hypothesize that patients with stable inspiratory flow will develop NED once the reflexes have been impaired with topical anesthetic. The investigators plan to: 1. measure upper airway muscle EMG to assess how it corresponds to the presence or absence of NED. This aim will allow us to test the hypothesis that robust upper airway muscle reflexes can protect against NED. 2. reduce upper airway muscle activity and reflexes by topical oropharyngeal anesthesia. This will allow us to test the hypothesis that attenuated upper airway muscle activity induced by topical anesthesia can induce NED.
Interventions
OTHERPharyngeal topical anesthesia
Pharyngeal topical anesthesia will be performed using 4% lidocaine spray
Sponsors
National Heart, Lung, and Blood Institute (NHLBI)
Brigham and Women's Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Normal subjects or patients with OSA
Exclusion criteria
* Any unstable cardiac condition (other than well controlled hypertension) or pulmonary problems. * Any medication known to influence breathing, sleep/arousal or muscle physiology * Concurrent sleep disorders (insomnia, narcolepsy, central sleep apnea or parasomnia) * Claustrophobia * Inability to sleep supine * Allergy to lidocaine or oxymetazoline HCl * For women: Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Negative effort dependence variation | After pharyngeal topical anesthesia | The magnitude of negative effort dependence will be expressed as the percent decrease in inspiratory flow from Vmax. NED will be compared before and after topical upper airway anesthesia |
Countries
United States
Outcome results
None listed