Nocturnal swallowing augments arousal intensity and arousal tachycardia

P. G. R. Burke*, S. G. Carter, F. Knapman, J. Patti, M. Butlin, S. C. Gandevia, J. E. Butler, D. J. Eckert, L. E. Bilston

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Cortical arousal from sleep is associated with autonomic activation and acute increases in heart rate. Arousals vary considerably in their frequency, intensity/duration, and physiological effects. Sleep and arousability impact health acutely (daytime cognitive function) and long-term (cardiovascular outcomes). Yet factors that modify the arousal intensity and autonomic activity remain enigmatic. In this study of healthy human adults, we examined whether reflex airway defense mechanisms, specifically swallowing or glottic adduction, influenced cardiac autonomic activity and cortical arousal from sleep. We found, in all subjects, that swallows trigger rapid, robust, and patterned tachycardia conserved across wake, sleep, and arousal states. Tachycardia onset was temporally matched to glottic adduction-the first phase of swallow motor program. Multiple swallows increase the magnitude of tachycardia via temporal summation, and blood pressure increases as a function of the degree of tachycardia. During sleep, swallows were overwhelmingly associated with arousal. Critically, swallows were causally linked to the intense, prolonged cortical arousals and marked tachycardia. Arousal duration and tachycardia increased in parallel as a function of swallow incidence. Our findings suggest that cortical feedback and tachycardia are integrated responses of the swallow motor program. Our work highlights the functional influence of episodic, involuntary airway defense reflexes on sleep and vigilance and cardiovascular function in healthy individuals.

Original languageEnglish
Pages (from-to)8624-8632
Number of pages9
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number15
Publication statusPublished - 14 Apr 2020


  • Arousal from sleep
  • Arousal tachycardia
  • Central pattern generation
  • Swallow

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