Awake negative pressure reflex response of the genioglossus in OSA patients and normal subjects

We hypothesized that the response of the genioglossus to negative pressure during wakefulness should be intact in obstructive sleep apnea (OSA) patients despite published evidence showing impairment of the response of palatal muscles (Mortimore IL and Douglas NJ. Am J Respir Crit Care Med 156: 867-873, 1997). Thus the response of the genioglossus to brief nasal negative pressure applications (NPAs) in early inspiration was compared between OSA patients and an age-matched group of normal subjects at two study sites (n = 11 per group in Long Beach, n = 14 per group in Boston). Subjects were studied in the sitting (Long Beach) or supine (Boston) posture, and the genioglossus electromyogram (EMGgg) was measured with an intraoral surface electrode (Long Beach) or intramuscular electrode (Boston). The response of the EMGgg was expressed as the percent change from baseline where the baseline EMGgg was the value at the onset of the NPA. In Long Beach, the EMGgg response was significantly higher in the OSA patients at a lower suction pressure of approximately 10 cmH(2)O (75.2 +/- 8.4 vs. 37.4 +/- 4.0% increase; P < 0.001) but not at a higher suction pressure of approximately 20 cmH(2)O. In Boston, the response in the OSA patients was also greater (107.2 +/- 25.9 vs. 46.3 +/- 8.3%; P < 0.05) at a suction pressure of approximately 13 cmH(2)O. We conclude that the response of the genioglossus to NPA during wakefulness is not impaired in OSA patients compared with normal subjects and is greater at low suction pressures.