Vom Vibrationstrauma zur gestörten Sensomotorik – Der Beginn eines Circulus vitiosus bei obstruktiver Schlafapnoe (OSA)?

Zusammenfassung

Kenntnisse über die Anatomie und nervale Versorgung von Oropharynx und Larynx sind notwendig, um Funktionen wie Atmen, Schlucken, Husten und Sprechen zu verstehen. In diesem Artikel soll ein Überblick über die sensomotorische Versorgung des oberen Atemwegs (OAW) gegeben werden. Der OAW sollte aufgrund seiner lebensnotwendigen Funktionen in besonderem Maße mit Rezeptoren und sensorischen Nervenfasern ausgestattet sein. Von Patienten mit obstruktiver Schlafapnoe (OSA) ist bekannt, dass sie im Zeitverlauf eine sensomotorische Neuropathie entwickeln. Es ist zu mutmaßen, dass die Weichteilvibration im oberen Atemweg, die mit Schnarchen einhergeht, über den Weg der gestörten Sensomotorik den initialen Mechanismus für die Entwicklung einer OSA darstellt. Der durch Vibration und Schnarchen in Gang gekommene Pathomechanismus könnte einen Circulus vitiosus zur Entwicklung einer OSA initiieren.

Abstract

Knowledge of the anatomy and neural innervation of the oropharynx and larynx is essential for understanding vital functions such as breathing, swallowing, coughing, and speaking. This article provides an overview of the sensorimotor innervation of the upper airway structures. The upper airway should be richly equipped with receptors and sensory nerve fibers due to its critical role in life-preserving protective reflexes. It is well established that patients with obstructive sleep apnea develop sensorimotor neuropathy over time. It is an interesting hypothesis that vibrations of the upper airway soft tissues and snoring are considered as likely trigger for this sensory neuropathy. Vibration and snoring could be the initial pathomechanism for a circulus vitiosus leading to obstructive sleep apnea.

Schlüsselwörter

pharyngeale Rezeptoren - laryngeale Rezeptoren - Mechanorezeptoren - Vibration - obstruktive Schlafapnoe - sensomotorische Neuropathie

Keywords

pharyngeal receptors - laryngeal receptors - mechanoreceptors - vibration - obstructive sleep apnea - sensory neuropathy

Publication History

Received: 24 June 2025

Accepted after revision: 29 December 2025

Article published online:
26 January 2026

• Literatur

• 1 Carlos F, Cobo J, Macias E. et al. The Sensory Innervation of the Human Pharynx: Searching for Mechanoreceptors. Anat Rec 2013; 296: 1735-1746
• 2 Cole CL, Mus M, Yu VX. et al. Healthy Human Laryngopharyngeal Sensory Innervation Density Correlates with Age. Laryngoscope 2023; 133: 773-784
• 3 Foote AG, Thibeault SL. Sensory Innervation of the Larynx and the Search for Mucosal Mechanoreceptors. J Speech Lang Hear Res 2021; 64: 371-391
• 4 Shah F, Stal P. Myopathy of the upper airway in snoring and obstructive sleep apnea. Laryngoscope Investig Otolaryngol 2022; 7: 636-645
• 5 Yu J. Airway mechanosensors. Respir Physiol & Neurobiol 2005; 148: 217-243
• 6 Setzen M, Mattucci KF. et al. Laryngopharyngeal sensory deficits as a predictor of aspiration. Otolaryngol Head Neck Surg 2001; 124: 622-624
• 7 Koehler U, Degerli M, Viniol C. et al. Dysphagia and obstructive sleep apnea (OSA): What is the pathophysiological bridge. Pneumologie 2025; 79: 632-636
• 8 Aviv JE. Clinical Assessment of Pharyngolaryngeal Sensitivity. Am J Med 2000; 108: 68-72
• 9 Friberg D, Ansved T, Borg K. et al. Histological Indications of a Progressive Snorers Disease in an Upper Airway Muscle. Am J Respir Crit Care Med 1998; 157: 586-593
• 10 Friberg D. Heavy Snorer’s Disease: a Progressive Local Neuropathy. Acta Otolaryngol 1999; 19: 925-933
• 11 Patel JA, Ray BJ, Fernandez-Salvador C. et al. Neuromuscular function of the soft palate and uvula in snoring and obstructive sleep apnea: A systematic review. Am J Otolaryngol 2018; 39: 327-337
• 12 Nail BS, Sterling GM, Widdicombe JG. Epipharyngeal Receptors Responding To Mechanical Stimulation. J Physiol 1969; 204: 91-98
• 13 Hwang JC, St John WM, Bartlett D. Receptors corresponding to changes in upper airway pressure. Respir Physiol 1984; 55: 355-366
• 14 Guilleminault C, Li K, Chen NH. et al. Two point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea syndrome, and normal control subjects. Chest 2002; 122: 866-870
• 15 Larsson H, Carlsson-Nordlander B, Lindblad LE. et al. Temperature thresholds in the oropharynx of patients with obstructive sleep apnea syndrome. Am Rev Respir Dis 1992; 146: 1246-1249
• 16 Hagander L, Harlid R, Svanborg E. Quantitative sensory testing in the oropharynx: a means of showing nervous lesions in patients with obstructive sleep apnea syndrome, and normal control subjects. Chest 2009; 136: 481-489
• 17 Kimoff RJ, Sforza E, Champagne V. et al. Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med 2001; 164: 250-255
• 18 Sunnergren O, Broström A, Svanborg E. How should sensory function in the oropharynx be tested? Cold thermal testing; a comparison of the methods of levels and limits. Clinical Neurophysiol 2010; 121: 1886-1889
• 19 Sunnergren O, Broström A, Svanborg E. Soft Palate Sensory Neuropathy in the Pathogenesis of Obstructive Sleep Apnea. Laryngoscope 2011; 121: 451-456
• 20 Nguyen AT, Jobin V, Payne R. et al. Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea. Sleep 2005; 28: 585-593
• 21 Diener HC, Fink GR. Therapie-Handbuch-Neurologie. 2. Aufl.. Elsevier Verlag; 2024
• 22 Handwerker HO, Schmelz M. Allgemeine Sinnesphysiologie. In: Lang F, Schmidt RF. , Hrsg. Physiologie des Menschen mit Pathophysiologie. 30. Aufl.. Springer Verlag; 2007
• 23 Valle ME, Cobo T, Vega JA. Mechanosensory Neurons, Cutaneous Mechanoreceptors, and Putative Mechanoproteins. Microsc Res Tech 2012; 75: 1033-1043
• 24 Mu L, Sanders I. Sensory Nerve Supply of the Human Oro- and Laryngopharynx: A Preliminary Study. Anat Rec 2000; 258: 406-420
• 25 Mu L, Chen J, Li J. et al. Sensory Innervation of the Human Soft Palate. Anat Rec 2018; 301: 1861-1870
• 26 Mu L, Chen J, Li J. et al. Innervation of human soft palate muscles. Anat Rec 2021; 304: 1054-1070
• 27 Lin YH, Hsieh SC, Chao CC. et al. Influence of aging on thermal and vibratory thresholds of quantitative sensory testing. J Peripheral Nervous System 2005; 10: 269-281
• 28 Heft MW, Robinson ME. Age Differences in Orofacial Sensory Thresholds. J Dent Res 2010; 89: 1102-1105
• 29 Nishino T. Physiological and Pathophysiological Implications of Upper Airway Reflexes in Humans. Jap J of Physiol 2000; 50: 3-14
• 30 Shen S, House RA. Hand-arm vibration syndrome. Can Fam Physician 2017; 63: 206-210
• 31 Poole CJ, Bovenzi M, Nilsson T. et al. International consensus criteria for diagnosing and staging hand-arm vibration syndrome. Int Arch Occup Environ Health 2019; 92: 117-127
• 32 Svanborg E, Ulander M, Broström A. et al. Palatal Sensory Function Worsens in Untreated Snorers but not in CPAP- Treated Patients With Sleep Apnea, Indicating Vibration Induced Nervous Lesions. Chest 2020; 157: 1296-1303
• 33 Bassiouny A, Nasr S, Mashaly M. et al. Electron microscopy study of peripheral nerves in the uvulae of snorers and obstructive sleep apnoea patients. J Laryngol Otol 2009; 123: 203-207
• 34 Tapia IE, Bandla P, Traylor J. et al. Upper Airway Sensory Function in Children with Obstructive Sleep Apnea. Sleep 2010; 33: 968-972
• 35 Tapia IE, Kim JY, Cornaglia MA. et al. Upper Airway Vibration Perception in School-Aged Children with Obstructive Sleep Apnea. Sleep 2016; 39: 1647-1652
• 36 Koehler U, Hildebrandt O, Degerli M. et al. From vibration trauma to pharyngeal muscle instability: A self-sustaining pathophysiological process (circulus vitiosus) in obstructive sleep apnea. Pneumologie 2024; 79: 297-301
• 37 Sarkis LM, Jones AC, Ng A. et al. Australasian Sleep Association position statement on consensus and evidence based treatment for primary snoring. Respirology 2023; 28: 110-119