Upper airway slumps during inspiration

Introduction In the normal NREM sleep phase, the basal tension of the upper airway muscle is reduced, the upper airway diameter is reduced, and the airway resistance is increased, but the discharge phase of the upper airway muscle and the rhythmic contraction of the intercostal muscle remain intact. The base tension of the upper airway muscles, the intercostal muscles, and most of the skeletal muscles is further suppressed during REM sleep. Decreased pharyngeal muscle tone can cause trapping of the upper airway during inhalation.

Cause

Respiratory muscle contraction is highly coordinated during normal breathing. The upper airway muscle has a certain base tension to keep the airway open. The nerve discharge causes the upper airway muscle to contract before each diaphragm contraction. The contraction of the genioglossus moves the tongue to fix the pharyngeal wall forward, further maintaining the upper airway opening and resisting the trapping effect of the negative pressure in the pharyngeal cavity on the upper airway. Subsequently, the intercostal muscle contraction stabilizes the chest wall, and the diaphragm contraction produces a pleural negative pressure to complete the inhalation. In the normal NREM sleep phase, the basal tension of the upper airway muscle is reduced, the upper airway diameter is reduced, and the airway resistance is increased, but the discharge phase of the upper airway muscle and the rhythmic contraction of the intercostal muscle remain intact. The base tension of the upper airway muscles, the intercostal muscles, and most of the skeletal muscles is further suppressed during REM sleep. Decreased pharyngeal muscle tone can cause trapping of the upper airway during inhalation. Decreased basal tension of the genioglossus can cause the base of the tongue to shift backwards and the airway to narrow. Decreased intercostal muscle tension can lead to instability of the chest wall during inhalation, resulting in contradictory movements of the chest and abdomen. In the REM sleep phase, the inspiratory phase discharge of the upper airway and intercostal muscle can also be inhibited. When the diaphragm negative pressure increases after the diaphragm contraction, the upper airway trapping tendency and chest wall instability are aggravated.

an examination

Related inspection

Blood routine chest perspective

More common in sleep-disordered breathing, apnea, although there is no airflow in the upper airway, but there is still chest and abdomen breathing exercise, and the chest negative pressure fluctuations can be as high as 7.8kPa (80cmH2O). Due to upper airway trapping, there is little or no external environmental gas entering the alveoli for gas exchange, which can result in severe hypoxemia and C02 retention, progressive bradycardia, and transient tachycardia at the end of the apnea. Occasionally, sinus block, atrioventricular septum, nodular or ventricular escape, hypoxemia-induced acidosis and myocardial ischemia produce atrial and ventricular ectopic rhythm. Severe OSAS patients are accompanied by daytime sleepiness, hypercapnia in waking, and even pulmonary hypertension and right heart failure.

Differential diagnosis

Chest pain during inhalation: one of the clinical manifestations of chest wall pain.

Features:

1. The place of pain is only concentrated, and the patient can clearly point it out.

2, the pain is not long, usually only one or two seconds each time, there is a chance to relapse.

3. When the patient takes a deep breath, coughs, sneezes or turns around, the chest is stinging and even painful. 4, the pain may be more intense than the chest pain caused by other diseases, but most of them improved within a few days to two, Samsung.

4. Any age will suffer.

Nasal obstruction during inhalation: The clinical manifestations of nasal valve stenosis are mainly nasal obstruction during inhalation, both unilateral and bilateral. The clinical manifestations were mainly nasal obstruction during inhalation. No abnormalities such as turbinate hypertrophy or polyps were found in the anterior nasal endoscopy. Lift the tip of the patient's nose and the nasal obstruction disappears immediately. If the thumb and forefinger are pushed to the sides of the nose, the nasal obstruction is immediately released, and the Cottle sign is positive.

There is a buzzing sound when inhaling: snoring breathing occurs mostly in patients with inhaled dyspnea. When the upper airway obstruction is difficult, the air is inhaled. When inhaling, a high-profile sound is called, which is called snoring breathing. Often accompanied by "three concave signs."

Intubation occurs in the chest: severe closed chest injury leads to multiple rib fractures, so that the local chest wall loses the rib support and softens, and abnormal breathing, that is, in the softened area, the chest wall is invaded when inhaling, exhalation For the chest.

More common in sleep-disordered breathing, apnea, although there is no airflow in the upper airway, but there is still chest and abdomen breathing exercise, and the chest negative pressure fluctuations can be as high as 7.8kPa (80cmH2O). Due to upper airway trapping, there is little or no external environmental gas entering the alveoli for gas exchange, which can result in severe hypoxemia and C02 retention, progressive bradycardia, and transient tachycardia at the end of the apnea. Occasionally, sinus block, atrioventricular septum, nodular or ventricular escape, hypoxemia-induced acidosis and myocardial ischemia produce atrial and ventricular ectopic rhythm. Severe OSAS patients are accompanied by daytime sleepiness, hypercapnia in waking, and even pulmonary hypertension and right heart failure.

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