Airway Obstruction in Sleep Apnea Patients

2018 ◽  
pp. 11-17 ◽  
Author(s):  
Magdalena Kostrzewska ◽  
Tomasz Trafas ◽  
Barbara Bromińska ◽  
Halina Batura-Gabryel ◽  
Sławomir Michalak ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction

scholarly journals Compensatory responses to upper airway obstruction in obese apneic men and women

2012 ◽  
Vol 112 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Chien-Hung Chin ◽  
Jason P. Kirkness ◽  
Susheel P. Patil ◽  
Brian M. McGinley ◽  
Philip L. Smith ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Rem Sleep ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Upper Airway Obstruction ◽  
Men And Women ◽  
Compensatory Responses ◽  
Obstructive Sleep

Defective structural and neural upper airway properties both play a pivotal role in the pathogenesis of obstructive sleep apnea. A more favorable structural upper airway property [pharyngeal critical pressure under hypotonic conditions (passive Pcrit)] has been documented for women. However, the role of sex-related modulation in compensatory responses to upper airway obstruction (UAO), independent of the passive Pcrit, remains unclear. Obese apneic men and women underwent a standard polysomnography and physiological sleep studies to determine sleep apnea severity, passive Pcrit, and compensatory airflow and respiratory timing responses to prolonged periods of UAO. Sixty-two apneic men and women, pairwise matched by passive Pcrit, exhibited similar sleep apnea disease severity during rapid eye movement (REM) sleep, but women had markedly less severe disease during non-REM (NREM) sleep. By further matching men and women by body mass index and age ( n = 24), we found that the lower NREM disease susceptibility in women was associated with an approximately twofold increase in peak inspiratory airflow ( P = 0.003) and inspiratory duty cycle ( P = 0.017) in response to prolonged periods of UAO and an ∼20% lower minute ventilation during baseline unobstructed breathing (ventilatory demand) ( P = 0.027). Thus, during UAO, women compared with men had greater upper airway and respiratory timing responses and a lower ventilatory demand that may account for sex differences in sleep-disordered breathing severity during NREM sleep, independent of upper airway structural properties and sleep apnea severity during REM sleep.

Obstructive Sleep Apnea and Its Therapy: Clinical and Polysomnographic Manifestations

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 737-742 ◽  
Author(s):  
Yitzchak Frank ◽  
Richard E. Kravath ◽  
Charles P. Pollak ◽  
Elliot D. Weitzman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Obstructive Sleep Apnea Syndrome ◽  
Medical Center ◽  
Sleep Apnea Syndrome ◽  
Sleep Stages ◽  
Sleep Wake Disorders ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Obstructive sleep apnea syndrome was studied in 32 children, aged 2 to 14 years, in the sleep-wake disorders center at Montefiore Hospital and Medical Center during the years 1977 to 1980. All children under-went all-night polysomnograms; 17 of these children had surgery to relieve airway obstruction and seven had a repeat polysomnographic study 4 to 6 weeks following the surgery. There was a significant improvement in the number of obstructive apneas and in other apnea indices following surgery. There was no significant effect on the durations and the proportions of the various sleep stages, on sleep efficiency, or on the number of awakenings.

scholarly journals 1244 A Curious Case of ASV Failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A474-A474
Author(s):  
Nishant Chaudhary ◽  
Mirna Ayache ◽  
John Carter
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Neck Extension ◽  
Sleep Study ◽  
Obstructive Sleep

Abstract Introduction Positive airway pressure-induced upper airway obstruction has been reported with the treatment of obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP) along with an oronasal interface. Here we describe a case of persistent treatment emergent central sleep apnea (TECSA) inadequately treated with adaptive servo ventilation (ASV), with an airflow pattern suggestive of ASV-induced upper airway obstruction. Report of Case A 32-year-old male, with severe OSA (apnea hypopnea index: 52.4) and no other significant past medical history, was treated with CPAP and required higher pressures during titration sleep studies to alleviate obstructive events, despite a Mallampati Class II airway and a normal body mass index. Drug-Induced Sleep Endoscopy (DISE) showed a complete velopharynx and oropharynx anterior posterior (AP) collapse, long soft palate, which improved with neck extension. CPAP therapy, however, did not result in any symptomatic benefit and compliance reports revealed high residual AHI and persistent TECSA. He underwent an ASV titration sleep study up to a final setting of expiratory positive airway pressure 9 cm H2O, pressure support 6-15 cm H2O (auto-rate), with a full-face mask due to high oral leak associated with the nasal interface. The ASV device detected central apneas and provided mandatory breaths, but did not capture the thorax or abdomen, despite normal mask pressure tracings. Several such apneas occurred, with significant oxyhemoglobin desaturation. Conclusion We postulate that the ASV failure to correct central sleep apnea as evidenced by the absence of thoracoabdominal inspiratory effort, occurred due to ASV-induced upper airway obstruction. Further treatment options for this ASV phenomenon are to pursue an ASV-assisted DISE and determine the effectiveness of adjunctive therapy including neck extension, nasal mask with a mouth closing device and a mandibular assist device.

Induction of airway collapse with subatmospheric pressure in awake patients with sleep apnea

1984 ◽  
Vol 57 (1) ◽  
pp. 140-146 ◽  
Author(s):  
P. M. Suratt ◽  
S. C. Wilhoit ◽  
K. Cooper
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Supine Position ◽  
Face Mask ◽  
Subatmospheric Pressure ◽  
Pharyngeal Airway ◽  
Airway Collapse ◽  
Obstructive Sleep ◽  
Obese Control

To determine whether the pharyngeal airway is abnormal in awake patients with obstructive sleep apnea (OSA), we measured the ability of the pharyngeal airway to resist collapse from subatmospheric pressure applied to the nose in awake subjects, 12 with OSA and 12 controls. Subatmospheric pressure was applied to subjects placed in the supine position through a tightly fitting face mask. We measured airflow at the mask as well as mask, pharyngeal, and esophageal pressures. Ten patients developed airway obstruction when subatmospheric pressures between 17 and 40 cmH2O were applied. Obstruction did not occur in two patients with the least OSA. Obstruction did not occur in 10 controls; one obese control subject developed partial airway obstruction when -52 cmH2O was applied as did another with -41 cmH2O. We conclude that patients with significant OSA have an abnormal airway while they are awake andthat application of subatmospheric pressure may be a useful screening test to detect OSA.

FEF25–75/FVC measurements and extrathoracic airway obstruction in obstructive sleep apnea patients

2005 ◽  
Vol 9 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Levent Öztürk ◽  
Gökhan Metin ◽  
Çağlar Çuhadaroğlu ◽  
Ayfer Utkusavaş ◽  
Bülent Tutluoğlu
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Obstructive Sleep ◽  
Extrathoracic Airway

A Multisensor Solid-State Pressure Manometer to Identify the Level of Collapse in Obstructive Sleep Apnea

1992 ◽  
Vol 107 (5) ◽  
pp. 651-656 ◽  
Author(s):  
B. Tucker Woodson ◽  
Marvin R. Wooten
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Solid State ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Specific Level ◽  
Obstructive Sleep ◽  
Distal Obstruction ◽  
Pressure Manometer ◽  
Pressure Catheter

The cause of failure after uvulopalatopharyngoplasty (UPPP) in idiopathic obstructive sleep apnea (OSA) is poorly understood, but has been speculated to be due, in part, to persistent collapse in the lower oropharynx. In order to determine the specific level of upper airway obstruction during sleep, a multisensor pressure catheter has been developed with five solid-state ultraminiature sensors. Four sensors in the pharynx simultaneously measure multiple pressure levels, with no need to move the catheter during sleep. One distal esophageal port measures the respiratory effort. To evaluate the use of this catheter, manometry in twelve patients was reviewed and compared to simultaneous videoendoscopy. The initial site of obstruction was the palate in nine patients (75%) and the tongue base in three (25%). Three patients with initial obstruction at the palate manometrically demonstrated distal obstruction on subsequent occluded breaths. Furthermore, simultaneous videoendoscopy in four patients with a palatal level of obstruction also identified marked near-total visual collapse without obstruction of the lower oropharynx that was not identified by pharyngeal manometry. The endoscopy revealed that at the initial site of obstruction, collapse appeared to have occurred passively during expiration and not on inspiration. Inferior to the site of mano-metric obstruction, collapse occurred during inspiration associated with increased negative inspiratory pressures. These results demonstrate that a multisensor pressure catheter can objectively identify the level of obstruction during sleep. However, manometry does not identify visually observed collapse at nonobstructive segments of the upper airway. Because such collapse and the associated increases in resistance may contribute to the pathology of airway obstruction in OSAS, manometry may miss pathologic segments of the upper airway in OSAS.

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