Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1995 Apr;50(4):376–382. doi: 10.1136/thx.50.4.376

Respiratory muscle activity during rapid eye movement (REM) sleep in patients with chronic obstructive pulmonary disease.

J E White 1, M J Drinnan 1, A J Smithson 1, C J Griffiths 1, G J Gibson 1
PMCID: PMC474282  PMID: 7785010

Abstract

BACKGROUND--In patients with chronic obstructive pulmonary disease (COPD) periods of hypopnoea occur during rapid eye movement (REM) sleep, but the mechanisms involved are not clear. METHODS--Ten patients with stable COPD were studied during nocturnal sleep. Detailed measurements were made of surface electromyographic (EMG) activity of several respiratory muscle groups and the accompanying chest wall motion using magnetometers. RESULTS--Hypopnoea occurred in association with eye movements during phasic rapid eye movement (pREM) sleep. During pREM sleep there were reductions in EMG activity of the intercostal, diaphragm, and upper airway muscles compared with non-REM sleep. Episodic hypopnoea due to partial upper airway occlusion ("obstructive" hypopnoea) was seen consistently in four subjects while the others showed the pattern of "central" hypopnoea accompanied by an overall reduction in inspiratory muscle activity. Although activity of the intercostal muscles was reduced relatively more than that of the diaphragm, lateral rib cage paradox (Hoover's sign) was less obvious during pREM-related hypopnoea than during wakefulness or non-REM sleep. CONCLUSIONS--Hypopnoea during REM sleep in patients with COPD is associated with reduced inspiratory muscle activity. The pattern of hypopnoea may be either "obstructive" or "central" and is generally consistent within an individual. Relatively unopposed action of the diaphragm on the rib cage during REM sleep is not accompanied by greater lateral inspiratory paradox.

Full text

PDF
376

Images in this article

378Image
on p.378

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Banzett R. B., Inbar G. F., Brown R., Goldman M., Rossier A., Mead J. Diaphragm electrical activity during negative lower torso pressure in quadriplegic men. J Appl Physiol Respir Environ Exerc Physiol. 1981 Sep;51(3):654–659. doi: 10.1152/jappl.1981.51.3.654. [DOI] [PubMed] [Google Scholar]
  2. Block A. J., Faulkner J. A., Hughes R. L., Remmers J. E., Thach B. Clinical conference in pulmonary disease. Factors influencing upper airway closure. Chest. 1984 Jul;86(1):114–122. doi: 10.1378/chest.86.1.114. [DOI] [PubMed] [Google Scholar]
  3. Catterall J. R., Douglas N. J., Calverley P. M., Shapiro C. M., Brezinova V., Brash H. M., Flenley D. C. Transient hypoxemia during sleep in chronic obstructive pulmonary disease is not a sleep apnea syndrome. Am Rev Respir Dis. 1983 Jul;128(1):24–29. doi: 10.1164/arrd.1983.128.1.24. [DOI] [PubMed] [Google Scholar]
  4. Chan C. S., Grunstein R. R., Bye P. T., Woolcock A. J., Sullivan C. E. Obstructive sleep apnea with severe chronic airflow limitation. Comparison of hypercapnic and eucapnic patients. Am Rev Respir Dis. 1989 Nov;140(5):1274–1278. doi: 10.1164/ajrccm/140.5.1274. [DOI] [PubMed] [Google Scholar]
  5. Douglas N. J., Calverley P. M., Leggett R. J., Brash H. M., Flenley D. C., Brezinova V. Transient hypoxaemia during sleep in chronic bronchitis and emphysema. Lancet. 1979 Jan 6;1(8106):1–4. doi: 10.1016/s0140-6736(79)90451-3. [DOI] [PubMed] [Google Scholar]
  6. Drinnan M. J., Murray A., White J. E., Smithson A. J., Gibson G. J., Griffiths C. J. Automated measurement of the cyclic activity of respiratory muscles. Med Eng Phys. 1994 Nov;16(6):477–483. doi: 10.1016/1350-4533(94)90072-8. [DOI] [PubMed] [Google Scholar]
  7. Fletcher E. C., Gray B. A., Levin D. C. Nonapneic mechanisms of arterial oxygen desaturation during rapid-eye-movement sleep. J Appl Physiol Respir Environ Exerc Physiol. 1983 Mar;54(3):632–639. doi: 10.1152/jappl.1983.54.3.632. [DOI] [PubMed] [Google Scholar]
  8. George C. F., West P., Kryger M. H. Oxygenation and breathing pattern during phasic and tonic REM in patients with chronic obstructive pulmonary disease. Sleep. 1987 Jun;10(3):234–243. doi: 10.1093/sleep/10.3.234. [DOI] [PubMed] [Google Scholar]
  9. Gilmartin J. J., Gibson G. J. Mechanisms of paradoxical rib cage motion in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1986 Oct;134(4):683–687. doi: 10.1164/arrd.1986.134.4.683. [DOI] [PubMed] [Google Scholar]
  10. Gould G. A., Gugger M., Molloy J., Tsara V., Shapiro C. M., Douglas N. J. Breathing pattern and eye movement density during REM sleep in humans. Am Rev Respir Dis. 1988 Oct;138(4):874–877. doi: 10.1164/ajrccm/138.4.874. [DOI] [PubMed] [Google Scholar]
  11. Gould G. A., Whyte K. F., Rhind G. B., Airlie M. A., Catterall J. R., Shapiro C. M., Douglas N. J. The sleep hypopnea syndrome. Am Rev Respir Dis. 1988 Apr;137(4):895–898. doi: 10.1164/ajrccm/137.4.895. [DOI] [PubMed] [Google Scholar]
  12. Griffiths C. J., Cooper B. G., Gibson G. J. A video system for investigating breathing disorders during sleep. Thorax. 1991 Feb;46(2):136–140. doi: 10.1136/thx.46.2.136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Griffiths C. J., Gilmartin J. J., Gibson G. J., Murray A. Measurement of chest wall movement; design, performance and clinical use of a four-channel magnetometer instrument. Clin Phys Physiol Meas. 1983 Nov;4(4):363–371. doi: 10.1088/0143-0815/4/4/001. [DOI] [PubMed] [Google Scholar]
  14. Guilleminault C., Cummiskey J., Motta J. Chronic obstructive airflow disease and sleep studies. Am Rev Respir Dis. 1980 Sep;122(3):397–406. doi: 10.1164/arrd.1980.122.3.397. [DOI] [PubMed] [Google Scholar]
  15. Hendricks J. C., Kline L. R. Differential activation within costal diaphragm during rapid-eye-movement sleep in cats. J Appl Physiol (1985) 1991 Mar;70(3):1194–1200. doi: 10.1152/jappl.1991.70.3.1194. [DOI] [PubMed] [Google Scholar]
  16. Hudgel D. W., Martin R. J., Capehart M., Johnson B., Hill P. Contribution of hypoventilation to sleep oxygen desaturation in chronic obstructive pulmonary disease. J Appl Physiol Respir Environ Exerc Physiol. 1983 Sep;55(3):669–677. doi: 10.1152/jappl.1983.55.3.669. [DOI] [PubMed] [Google Scholar]
  17. Johnson M. W., Remmers J. E. Accessory muscle activity during sleep in chronic obstructive pulmonary disease. J Appl Physiol Respir Environ Exerc Physiol. 1984 Oct;57(4):1011–1017. doi: 10.1152/jappl.1984.57.4.1011. [DOI] [PubMed] [Google Scholar]
  18. Leitch A. G., Clancy L. J., Leggett R. J., Tweeddale P., Dawson P., Evans J. I. Arterial blood gas tensions, hydrogen ion, and electroencephalogram during sleep in patients with chronic ventilatory failure. Thorax. 1976 Dec;31(6):730–735. doi: 10.1136/thx.31.6.730. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Littner M. R., McGinty D. J., Arand D. L. Determinants of oxygen desaturation in the course of ventilation during sleep in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1980 Dec;122(6):849–857. doi: 10.1164/arrd.1980.122.6.849. [DOI] [PubMed] [Google Scholar]
  20. Millman R. P., Knight H., Kline L. R., Shore E. T., Chung D. C., Pack A. I. Changes in compartmental ventilation in association with eye movements during REM sleep. J Appl Physiol (1985) 1988 Sep;65(3):1196–1202. doi: 10.1152/jappl.1988.65.3.1196. [DOI] [PubMed] [Google Scholar]
  21. Muller N. L., Francis P. W., Gurwitz D., Levison H., Bryan A. C. Mechanism of hemoglobin desaturation during rapid-eye-movement sleep in normal subjects and in patients with cystic fibrosis. Am Rev Respir Dis. 1980 Mar;121(3):463–469. doi: 10.1164/arrd.1980.121.3.463. [DOI] [PubMed] [Google Scholar]
  22. Neilly J. B., Gaipa E. A., Maislin G., Pack A. I. Ventilation during early and late rapid-eye-movement sleep in normal humans. J Appl Physiol (1985) 1991 Oct;71(4):1201–1215. doi: 10.1152/jappl.1991.71.4.1201. [DOI] [PubMed] [Google Scholar]
  23. Ninane V., Rypens F., Yernault J. C., De Troyer A. Abdominal muscle use during breathing in patients with chronic airflow obstruction. Am Rev Respir Dis. 1992 Jul;146(1):16–21. doi: 10.1164/ajrccm/146.1.16. [DOI] [PubMed] [Google Scholar]
  24. Sauerland E. K., Sauerland B. A., Orr W. C., Hairston L. E. Non-invasive electromyography of human genioglossal (tongue) activity. Electromyogr Clin Neurophysiol. 1981 Feb-Mar;21(2-3):279–286. [PubMed] [Google Scholar]
  25. Staats B. A., Bonekat H. W., Harris C. D., Offord K. P. Chest wall motion in sleep apnea. Am Rev Respir Dis. 1984 Jul;130(1):59–63. doi: 10.1164/arrd.1984.130.1.59. [DOI] [PubMed] [Google Scholar]
  26. Tabachnik E., Muller N. L., Bryan A. C., Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Physiol Respir Environ Exerc Physiol. 1981 Sep;51(3):557–564. doi: 10.1152/jappl.1981.51.3.557. [DOI] [PubMed] [Google Scholar]
  27. Wells D. T., Allen R. P., Wagman A. M. A single-channel system for recording eye movements. Psychophysiology. 1977 Jan;14(1):73–74. doi: 10.1111/j.1469-8986.1977.tb01160.x. [DOI] [PubMed] [Google Scholar]
  28. Wiegand L., Zwillich C. W., Wiegand D., White D. P. Changes in upper airway muscle activation and ventilation during phasic REM sleep in normal men. J Appl Physiol (1985) 1991 Aug;71(2):488–497. doi: 10.1152/jappl.1991.71.2.488. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES