ArticleJournal of applied physiology (Bethesda, Md. : 1985)2014
The classical Starling resistor model often does not predict inspiratory airflow patterns in the human upper airway.
Article in Journal of applied physiology (Bethesda, Md. : 1985), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- The Association of Upper Airway Anatomy and Hypoglossal Nerve Stimulation Response in OSA.The Laryngoscope · 2026Article
- Mechanisms and Management of Obstructive Sleep Apnea: A Translational Overview.Clinical and experimental otorhinolaryngology · 2025Review
- Comparison of Four Mechanical Insufflation-Exsufflation Devices: Effect of Simulated Airway Collapse on Cough Peak Flow.Respiratory care · 2023Article
- The impact of daytime transoral neuromuscular stimulation on upper airway physiology - A mechanistic clinical investigation.Physiological reports · 2022Article
- Critical to Know Pcrit: A Review on Pharyngeal Critical Closing Pressure in Obstructive Sleep Apnea.Frontiers in neurology · 2022Review
- Pathogenesis of obstructive sleep apnea in individuals with the COPD + OSA Overlap syndrome versus OSA alone.Physiological reports · 2020Article
- Precision Medicine for Obstructive Sleep Apnea.Sleep medicine clinics · 2019Review
- Airflow limitation in a collapsible model of the human pharynx: physical mechanisms studied with fluid-structure interaction simulations and experiments.Physiological reports · 2019Article
- Retropalatal and retroglossal airway compliance in patients with obstructive sleep apnea.Respiratory physiology & neurobiology · 2018Article
- Physiology-Based Modeling May Predict Surgical Treatment Outcome for Obstructive Sleep Apnea.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2017Observational
- An Official American Thoracic Society Workshop Report: Noninvasive Identification of Inspiratory Flow Limitation in Sleep Studies.Annals of the American Thoracic Society · 2017Article
- New Approaches to Diagnosing Sleep-Disordered Breathing.Sleep medicine clinics · 2016Review
- Upper Airway Collapsibility (Pcrit) and Pharyngeal Dilator Muscle Activity are Sleep Stage Dependent.Sleep · 2016Article
- Test of the Starling resistor model in the human upper airway during sleep.Journal of applied physiology (Bethesda, Md. : 1985) · 2014Article
- Influence of pharyngeal muscle activity on inspiratory negative effort dependence in the human upper airway.Respiratory physiology & neurobiology · 2014Article
- CrossTalk opposing view: Loop gain is not a consequence of obstructive sleep apnoea.The Journal of physiology · 2014Article
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Authors and funding
8 authors.
Funding
Abstract
The upper airway is often modeled as a classical Starling resistor, featuring a constant inspiratory airflow, or plateau, over a range of downstream pressures. However, airflow tracings from clinical sleep studies often show an initial peak before the plateau. To conform to the Starling model, the initial peak must be of small magnitude or dismissed as a transient. We developed a method to simulate fast or slow inspirations through the human upper airway, to test the hypothesis that this initial peak is a transient. Eight subjects [4 obstructive sleep apnea (OSA), 4 controls] slept in an "iron lung" and wore a nasal mask connected to a continuous/bilevel positive airway pressure machine. Downstream pressure was measured using an epiglottic catheter. During non-rapid eye movement (NREM) sleep, subjects were hyperventilated to produce a central apnea, then extrathoracic pressure was decreased slowly (∼2-4 s) or abruptly (<0.5 s) to lower downstream pressure and create inspiratory airflow. Pressure-flow curves were constructed for flow-limited breaths, and slow vs. fast reductions in downstream pressure were compared. All subjects exhibited an initial peak and then a decrease in flow with more negative pressures, demonstrating negative effort dependence (NED). The rate of change in downstream pressure did not affect the peak to plateau airflow ratio: %NED 22 ± 13% (slow) vs. 20 ± 5% (fast), P = not significant. We conclude that the initial peak in inspiratory airflow is not a transient but rather a distinct mechanical property of the upper airway. In contrast to the classical Starling resistor model, the upper airway exhibits marked NED in some subjects.
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