EFFECT OF ELECTRICAL-STIMULATION OF THE HYPOGLOSSAL NERVE ON AIR-FLOW MECHANICS IN THE ISOLATED UPPER AIRWAY

To determine the influence of electrical hypoglossal (HG) nerve stimulation on upper airway airflow mechanics, we analyzed pressure-flow relationships obtained during bilateral supramaximal HG nerve stimulation over a range of frequencies from 0 to 100 Hz in the isolated feline upper airway. Inspiratory airflow (VI), hypopharyngeal pressure (Php), and pharyngeal pressure (Pph) immediately upstream from the flow-limiting site (FLS) were recorded while Php was rapidly lowered to achieve inspiratory flow limitation in the isolated upper airway. Pressure-flow relationships were analyzed to determine the maximum in VI (VImax) and the mechanical determinants of VImax, the upper airway critical pressure (Pcrit) and the nasal resistance (RN) upstream to the FLS. In groups of decerebrate spinally anesthetized (n = 6) and unanesthetized (n = 6) cats, graded increases in VImax (p < 0.05) and decreases in Pcrit (p < 0.001) were observed as the stimulation frequency of the intact HG nerves was increased. In the cats with and without spinal anesthesia, VImax increased by 139 and 201%, and Pcrit decreased by 159 and 280%, respectively. RN was also correlated with stimulation frequency in the cats without spinal anesthesia (p = 0.01) and increased in four of six cats with spinal anesthesia. In an additional six decerebrate cats, significant increases in VImax (p < 0.001) and decreases in Pcrit (p = 0.01) were elicited by stimulating the distal cut HG nerve ends (50 Hz), whereas no changes were noted in these parameters when the proximal ends were stimulated. The findings suggest that HG stimulation increases VImax by decreasing Pcrit, which indicates a decrease in upper airway collapsibility at the FLS. We speculate that this fall in collapsibility was due to tongue protrusion, which decreased the tissue pressure surrounding the FLS in the velopharyngeal region. Increases in VImax, however, were partially offset by concomitant increases in RN, which may have been due to narrowing of the upstream segment.