{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T22:28:55Z","timestamp":1771799335707,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T00:00:00Z","timestamp":1359676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Experimental Physiology"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:title>New Findings<\/jats:title><jats:p><jats:list list-type=\"explicit-label\">\n<jats:list-item><jats:p><jats:bold>What is the central question of this study?<\/jats:bold><\/jats:p><jats:p>Peripheral hypoglossal nerve stimulation is a novel therapeutic approach aimed at recruiting lingual muscles electrically and thus relieving pharyngeal airflow obstruction during sleep but the effects of corticomotor stimulation of upper airway muscles during sleep are unknown.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p><jats:bold>What is the main finding and its importance?<\/jats:bold><\/jats:p><jats:p>Using transcranial magnetic stimulation, we show that corticobulbar excitability of the submental muscles is decreased during sleep in apnoeic patients. Furthermore, we demonstrate that transcranial magnetic stimulation briefly recruits submental muscles and increases maximal inspiratory flow as well as the inspiratory volume of flow\u2010limited respiratory cycles without arousing patients from sleep. We suggest that this central neurostimulation approach is capable of improving upper airway mechanics in sleep apnoea patients.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p>Transcranial magnetic stimulation (TMS) can activate the corticobulbar system and briefly recruit upper airway dilator muscles, improving the inspiratory airflow dynamics of flow\u2010limited respiratory cycles during sleep. The purpose of this investigation was to quantify the effects of TMS\u2010induced twitches applied during sleep on flow\u2010limited respiratory cycles in 14 obstructive sleep apnoea patients. Submental muscle motor threshold (SUB<jats:sub>MT<\/jats:sub>) and motor\u2010evoked potential (SUB<jats:sub>MEP<\/jats:sub>) were examined during wakefulness and sleep. The TMS\u2010induced twitches were applied during stable non\u2010rapid eye movement (NREM) sleep, during non\u2010consecutive flow\u2010limited respiratory cycles at the beginning of inspiration, with intensities varying from sleep SUB<jats:sub>MT<\/jats:sub> up to maximal stimulation without arousal. Maximal inspiratory flow, inspiratory volume, shifts of electroencephalogram frequency and pulse rate variability were assessed. Cortical and\/or autonomic arousal after TMS was observed in only 13.8% of all twitches applied. The SUB<jats:sub>MT<\/jats:sub> increased during NREM sleep (wakefulness, 24.8 \u00b1 9.3%; and NREM sleep, 28.3 \u00b1 9.5%; <jats:italic>P<\/jats:italic>= 0.003). Augmenting stimulator output from SUB<jats:sub>MT<\/jats:sub> to maximal stimulation before arousal enhanced SUB<jats:sub>MEP<\/jats:sub> peak\u2010to\u2010peak amplitude (from 0.09 \u00b1 0.05 to 0.4 \u00b1 0.3 mV; <jats:italic>P<\/jats:italic>= 0.005) with a concomitant rise in maximal inspiratory flow (from 376.2 \u00b1 107.9 to 411.9 \u00b1 109.3 ml s<jats:sup>\u22121<\/jats:sup>; <jats:italic>P<\/jats:italic>= 0.008) and inspiratory volume (from 594.8 \u00b1 189.2 to 663.7 \u00b1 203.1 ml; <jats:italic>P<\/jats:italic>= 0.001) in all but one patient. Corticobulbar excitability of submental muscles decreases during NREM sleep. Brief recruitment of submental muscles with TMS during sleep improves upper airway mechanics without arousing patients from sleep.<\/jats:p>","DOI":"10.1113\/expphysiol.2012.070359","type":"journal-article","created":{"date-parts":[[2012,12,8]],"date-time":"2012-12-08T07:18:18Z","timestamp":1354951098000},"page":"946-956","source":"Crossref","is-referenced-by-count":21,"title":["Acute upper airway muscle and inspiratory flow responses to transcranial magnetic stimulation during sleep in apnoeic patients"],"prefix":"10.1113","volume":"98","author":[{"given":"C\u00e9sar Augusto","family":"Melo\u2010Silva","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean\u2010Christian","family":"Borel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Gakwaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"S\u00e9ri\u00e8s","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,2]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-008-1274-3"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2869.2003.00379.x"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00713.2011"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2011.06.008"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2869.2004.00391.x"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00581.2002"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00043.2008"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.1380"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1997.01900010067009"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000038762.11894.DA"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2008.06.012"},{"key":"e_1_2_5_13_1","first-page":"406","article-title":"The tongue and its control by sleep state\u2010dependent modulators","volume":"149","author":"Horner RL","year":"2011","journal-title":"Arch Ital Biol"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0034-5687(99)00110-3"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1999.86.1.411"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/29.2.240"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2005.04.015"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neulet.2004.01.081"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2005.12.003"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01542.2011"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-980X(96)96598-4"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199601000-00003"},{"key":"e_1_2_5_23_1","volume-title":"Magnetic Stimulation of the Human Nervous System","author":"Mills K","year":"1999"},{"key":"e_1_2_5_24_1","article-title":"Targeted hypoglossal neurostimulation for obstructive sleep apnoea. 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