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March 4, 1992

Pathophysiology of Upper Airway Closures During Sleep-Reply

Author Affiliations

University of Texas Medical Branch at Galveston

JAMA. 1992;267(9):1207. doi:10.1001/jama.1992.03480090054020

In Reply.  —Dr Woodcock's data do not support the conclusion that nasal airway resistance is unlikely to be important in the causation of OSA. As emphasized in our article, upper airway closure during sleep can be caused by changes in pharyngeal closing pressure, pharyngeal muscle force, and/or pharyngeal suction force. While not all OSA patients have abnormally high nasal airway resistance, individuals with an abnormally high nasal airway resistance from nasal septal deviation, nasal polyps, or chronic nasal congestion, are at increased risk of developing upper airway closure during sleep.1-3 Abnormally high upstream resistance increases transmission of subatmospheric intrathoracic pressure into the potentially collapsible pharyngeal airway. Improvement in OSA has been reported with correction of abnormally high nasal airway resistance.4 However, correction of abnormally high nasal airway resistance may not improve OSA depending on pharyngeal closing pressure and pharyngeal muscle force. Treatment of these latter patients may be