ArticleJournal of applied physiology (Bethesda, Md. : 1985)2014
Test of the Starling resistor model in the human upper airway during sleep.
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 17 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Anatomical determinants of upper airway collapsibility in obstructive sleep apnea: A systematic review and meta-analysis.Sleep medicine reviews · 2023Pooled it
- A Comparison of Snoring Changes With a Supine-Avoidance Alarm Device Compared to Constant Positive Airway Pressure Treatment in Patients With Supine-Predominant OSA.Journal of sleep research · 2026Trial
- Three-dimensional upper airway phenotyping and OSA severity: a CT-based study.European radiology · 2026Article
- Phrenic nerve stimulation enhances upper airway patency during drug-induced sleep endoscopy in obstructive sleep apnea.Annals of the American Thoracic Society · 2026Article
- Mechanical mechanism study of upper airway collapse and twin block treatment in a patient with mandibular retrognathia using fluid-structure interaction simulation.BMC oral health · 2025Article
- Mechanisms and Management of Obstructive Sleep Apnea: A Translational Overview.Clinical and experimental otorhinolaryngology · 2025Review
- A Pilot Study: The Effect of CPAP Intervention on Sleep Architecture and Cognition in Alzheimer's Disease Patients with Obstructive Sleep Apnea.Neurology international · 2025Article
- Phenotypes of Velopharyngeal Tube Law in Obstructive Sleep Apnea.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2025Article
- Much Ado about Sleep: Current Concepts on Mechanisms and Predisposition to Pediatric Obstructive Sleep Apnea.Children (Basel, Switzerland) · 2021Review
- Qualitative Phenotyping of Obstructive Sleep Apnea and Its Clinical Usefulness for the Sleep Specialist.International journal of environmental research and public health · 2020Review
- 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
- Phenotyping the pathophysiology of obstructive sleep apnea using polygraphy/polysomnography: a review of the literature.Sleep & breathing = Schlaf & Atmung · 2018Review
- Simulation of the upper airways in patients with obstructive sleep apnea and nasal obstruction: A novel finite element method.Laryngoscope investigative otolaryngology · 2018Article
- Article
- 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
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
The human pharyngeal airway during sleep is conventionally modeled as a Starling resistor. However, inspiratory flow often decreases with increasing effort (negative effort dependence, NED) rather than remaining fixed as predicted by the Starling resistor model. In this study, we tested a major prediction of the Starling resistor model--that the resistance of the airway upstream from the site of collapse remains fixed during flow limitation. During flow limitation in 24 patients with sleep apnea, resistance at several points along the pharyngeal airway was measured using a pressure catheter with multiple sensors. Resistance between the nose and the site of collapse (the upstream segment) was measured before and after the onset of flow limitation to determine whether the upstream dimensions remained fixed (as predicted by the Starling resistor model) or narrowed (a violation of the Starling resistor model). The upstream resistance from early to mid inspiration increased considerably during flow limitation (by 35 ± 41 cmH2O · liter(-1) · s(-1), P < 0.001). However, there was a wide range of variability between patients, and the increase in upstream resistance was strongly correlated with the amount of NED (r = 0.75, P < 0.001). Therefore, patients with little NED exhibited little upstream narrowing (consistent with the Starling model), and patients with large NED exhibited large upstream narrowing (inconsistent with the Starling model). These findings support the idea that there is not a single model of pharyngeal collapse, but rather that different mechanisms may dominate in different patients. These differences could potentially be exploited for treatment selection.
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Registered trials
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