Ventilatory Control and Airway Anatomy in Obstructive Sleep Apnea

Ventilatory instability may play an important role in the pathogenesis of obstructive sleep apnea. We hypothesized that the influence of ventilatory instability in this disorder would vary depending on the underlying collapsibility of the upper airway. To test this hypothesis, we correlated loop gai...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2004-12, Vol.170 (11), p.1225-1232
Main Authors: Wellman, Andrew, Jordan, Amy S, Malhotra, Atul, Fogel, Robert B, Katz, Eliot S, Schory, Karen, Edwards, Jill K, White, David P
Format: Article
Language:English
Subjects:
Adult
Airway management
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Apnea - physiopathology
Biological and medical sciences
Biomechanical Phenomena
Chronic obstructive pulmonary disease, asthma
Emergency and intensive respiratory care
Eye movements
Feedback
Female
Humans
Intensive care medicine
Male
Medical sciences
Middle Aged
Pharynx - anatomy & histology
Pharynx - physiopathology
Pneumology
Polysomnography
Pulmonary Ventilation - physiology
Regression analysis
Respiration
Sleep apnea
Sleep Apnea, Obstructive - physiopathology
Sleep Stages
Ventilators
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Summary:Ventilatory instability may play an important role in the pathogenesis of obstructive sleep apnea. We hypothesized that the influence of ventilatory instability in this disorder would vary depending on the underlying collapsibility of the upper airway. To test this hypothesis, we correlated loop gain with apnea-hypopnea index during supine, nonrapid eye movement sleep in three groups of patients with obstructive sleep apnea based on pharyngeal closing pressure: negative pressure group (pharyngeal closing pressure less than -1 cm H(2)O), atmospheric pressure group (between -1 and +1 cm H(2)O), and positive pressure group (greater than +1 cm H(2)O). Loop gain was measured by sequentially increasing proportional assist ventilation until periodic breathing developed, which occurred in 24 of 25 subjects. Mean loop gain for all three groups was 0.37 +/- 0.11. A significant correlation was found between loop gain and apnea-hypopnea index in the atmospheric group only (r = 0.88, p = 0.0016). We conclude that loop gain has a substantial impact on apnea severity in certain patients with sleep apnea, particularly those with a pharyngeal closing pressure near atmospheric.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.200404-510OC