RATIONALE Ansa cervicalis stimulation (ACS) of the infrahyoid muscles has been proposed as a neurostimulation therapy for obstructive sleep apnea (OSA). ACS stabilizes the pharynx by pulling it caudally, but its specific effects on flow limitation caused by palatal, oropharyngeal lateral wall, tongue base, or epiglottis collapse remains unclear. OBJECTIVES To quantify the effect of ACS on collapsibility of different pharyngeal flow-limiting structures. METHODS Participants with OSA underwent bilateral ACS during drug-induced sleep endoscopy. Maximum inspiratory airflow was assessed over a range of positive airway pressures while ACS was applied. The flow-limiting structure for each breath was classified based on manometric and endoscopic findings and a linear mixed-effects model characterized their response to ACS. The influence of patient characteristics was explored with univariate models. MEASUREMENTS AND MAIN RESULTS Forty-one participants yielded 1761 breaths for analysis. On average, bilateral ACS decreased the observed pharyngeal critical closing (PCRIT) and opening (POPEN) pressures by -3.0 [95% confidence interval: [-3.6, -2.3] and -3.7 [-4.4, -3.0] cmH2O, respectively (p<0.001). During tongue base obstruction, modeled ACS effects for PCRIT and POPEN were -2.0 [-2.7, -1.4] and -3.1 [-3.8, -2.4] cmH2O, respectively (p<0.001). Greater reductions were generally observed for other flow-limiting structures. A lower apnea-hypopnea index was associated with a greater decrease in POPEN (p<0.01). Other patient characteristics, including body mass index, did not influence PCRIT or POPEN (p>0.05). CONCLUSIONS Bilateral ACS decreased collapsibility of all airway flow-limiting structures. ACS generally had greater effects on palatal, oropharyngeal lateral wall, and epiglottic collapse than the tongue base.

中文翻译：

---

Ansa cervicalis 刺激对上气道通畅性的影响：基于结构的分析。


基本原理 舌骨下肌的颈椎刺激 （ACS） 已被提议作为阻塞性睡眠呼吸暂停 （OSA） 的神经刺激疗法。ACS 通过向尾部拉动咽部来稳定咽部，但其对腭部、口咽侧壁、舌根或会厌塌陷引起的血流受限的具体影响尚不清楚。目的 量化 ACS 对不同咽部限流结构塌陷性的影响。方法 OSA 参与者在药物诱导的睡眠内窥镜检查期间接受了双侧 ACS。在应用 ACS 时，在气道正压通气范围内评估最大吸气气流。根据测压和内窥镜检查结果对每次呼吸的限流结构进行分类，线性混合效应模型表征了他们对 ACS 的反应。使用单变量模型探讨了患者特征的影响。测量和主要结果 41 名参与者产生了 1761 次呼吸进行分析。平均而言，双侧 ACS 使观察到的咽部临界闭合 （PCRIT） 和开口 （POPEN） 压力分别降低了 -3.0 [95% 置信区间： [-3.6， -2.3] 和 -3.7 [-4.4， -3.0] cmH2O （p<0.001）。在舌基梗阻期间，PCRIT 和 POPEN 的建模 ACS 效应分别为 -2.0 [-2.7， -1.4] 和 -3.1 [-3.8， -2.4] cmH2O （p<0.001）。通常观察到其他限流结构的减少幅度更大。较低的呼吸暂停低通气指数与 POPEN 的较大降低相关 （p<0.01）。其他患者特征，包括体重指数，不影响 PCRIT 或 POPEN （p>0.05）。结论 双侧 ACS 降低了所有气道限流结构的塌陷性。 ACS 对腭、口咽侧壁和会厌塌陷的影响通常大于舌根。