Influence of pharyngeal muscle activity on inspiratory negative effort dependence in the human upper airway

• The shape of inspiratory flow limitation in obstructive sleep apnea varies.
• Some exhibit little, others demonstrate considerable negative effort dependence (NED).
• We assessed NED before and after pharyngeal topical anesthesia with lidocaine.
• The effect of pharyngeal anesthesia on NED was small.
• This suggests a limited role of airway muscle activation in NED.

The upper airway is often modeled as a Starling resistor, which predicts that flow is independent of inspiratory effort during flow limitation. However, while some obstructive sleep apnea (OSA) patients exhibit flat, Starling resistor-like flow limitation, others demonstrate considerable negative effort dependence (NED), defined as the percent reduction in flow from peak to mid-inspiration. We hypothesized that the variability in NED could be due to differences in phasic pharyngeal muscle activation between individuals. Therefore, we induced topical pharyngeal anesthesia to reduce phasic pharyngeal muscle activation to see if it increased NED.Twelve subjects aged 50 ± 10 years with a BMI of 35 ± 6 kg/m2 and severe OSA (apnea-hypopnea index = 52 ± 28 events/h) were studied. NED and phasic genioglossus muscle activity (EMGGG) of flow limited breaths were determined before and after pharyngeal anesthesia with lidocaine. Pharyngeal anesthesia led to a 33% reduction in EMGGG activity (p < 0.001), but NED worsened only by 3.6 ± 5.8% (p = 0.056).In conclusion, phasic EMGGG had little effect on NED. This finding suggests that individual differences in phasic EMGGG activation do not likely explain the variability in NED found among OSA patients.