Upper Airway Tone May Be Compromised During Sleep

A prominent feature during REM sleep is a general reduction in skeletal muscle tone. Muscles of the larynx, pharynx, and tongue share in this relaxation, which can lead to obstruction of the upper airways. Airway muscle relaxation may be enhanced by the increased effectiveness of the lung inflation reflex.

A common consequence of airway narrowing during sleep is snoring. In many people, usually men, the degree of obstruction may at times be sufficient to cause essentially complete occlusion. In these people, an intact arousal mechanism prevents suffocation, and this sequence is not in itself unusual or abnormal. In some people, obstruction is more complete and more frequent, and the arousal threshold may be raised. Repeated obstruction leads to significant hypercapnia and hypoxemia, and repeated arousals cause sleep deprivation that leads to excessive daytime sleepiness, often interfering with normal daily activity.

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