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Upper airway collapsibility measured using a simple wakefulness test closely relates to the pharyngeal critical closing pressure during sleep in obstructive sleep apnea
- Source :
- Sleep. 42(7)
- Publication Year :
- 2018
-
Abstract
- Study ObjectivesA collapsible or crowded pharyngeal airway is the main cause of obstructive sleep apnea (OSA). However, quantification of airway collapsibility during sleep (Pcrit) is not clinically feasible. The primary aim of this study was to compare upper airway collapsibility using a simple wakefulness test with Pcrit during sleep.MethodsParticipants with OSA were instrumented with a nasal mask, pneumotachograph and two pressure sensors, one at the choanae (PCHO), the other just above the epiglottis (PEPI). Approximately 60 brief (250 ms) pulses of negative airway pressure (~ –12 cmH2O at the mask) were delivered in early inspiration during wakefulness to measure the upper airway collapsibility index (UACI). Transient reductions in the continuous positive airway pressure (CPAP) holding pressure were then performed during sleep to determine Pcrit. In a subset of participants, the optimal number of replicate trials required to calculate the UACI was assessed.ResultsThe UACI (39 ± 24 mean ± SD; range = 0%–87%) and Pcrit (–0.11 ± 2.5; range: –4 to +5 cmH2O) were quantified in 34 middle-aged people (9 female) with varying OSA severity (apnea–hypopnea index range = 5–92 events/h). The UACI at a mask pressure of approximately –12 cmH2O positively correlated with Pcrit (r = 0.8; p < 0.001) and could be quantified reliably with as few as 10 replicate trials. The UACI performed well at discriminating individuals with subatmospheric Pcrit values [receiver operating characteristic curve analysis area under the curve = 0.9 (0.8–1), p < 0.001].ConclusionsThese findings indicate that a simple wakefulness test may be useful to estimate the extent of upper airway anatomical impairment during sleep in people with OSA to direct targeted non-CPAP therapies for OSA.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Polysomnography
Respiratory physiology
Physiology (medical)
Internal medicine
medicine
Humans
Continuous positive airway pressure
Wakefulness
Aged
Sleep Apnea, Obstructive
Receiver operating characteristic
Continuous Positive Airway Pressure
business.industry
Respiration
Pharynx
Middle Aged
medicine.disease
Critical closing pressure
respiratory tract diseases
Obstructive sleep apnea
medicine.anatomical_structure
Cardiology
Female
Neurology (clinical)
Airway
business
Sleep
Subjects
Details
- ISSN :
- 15509109
- Volume :
- 42
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Sleep
- Accession number :
- edsair.doi.dedup.....cd2c957076c8ceb5bfc3e270414d5314