Fraction of apnea is associated with the required continuous positive airway pressure level and reflects upper airway collapsibility in patients with obstructive sleep apnea

2021 ◽  
Author(s):  
Hideaki Nakayama ◽  
Youichiro Takei ◽  
Mina Kobayashi ◽  
Mariko Yanagihara ◽  
Yuichi Inoue
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Pressure Level ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility

scholarly journals Upper airway collapsibility measured using a simple wakefulness test closely relates to the pharyngeal critical closing pressure during sleep in obstructive sleep apnea

SLEEP ◽  
2019 ◽  
Vol 42 (7) ◽  
Author(s):  
Amal M Osman ◽  
Jayne C Carberry ◽  
Peter G R Burke ◽  
Barbara Toson ◽  
Ronald R Grunstein ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Pressure Sensors ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Pharyngeal Airway ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility

AbstractStudy 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.

scholarly journals Continuous positive airway pressure treatment does not normalize the prolonged reflex inhibition to inspiratory loading in obstructive sleep apnea

2016 ◽  
Vol 121 (4) ◽  
pp. 910-916
Author(s):  
Nicholas P. S. Murray ◽  
David K. McKenzie ◽  
Simon C. Gandevia ◽  
Jane E. Butler
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Cpap Therapy ◽  
Airway Occlusion ◽  
Obstructive Sleep

In obstructive sleep apnea (OSA), the short-latency inhibitory reflex (IR) of inspiratory muscles to airway occlusion is prolonged in proportion to the severity of the OSA. The mechanism underlying the prolongation may relate to chronic inspiratory muscle loading due to upper airway obstruction or sensory changes due to chronic OSA-mediated inflammation. Continuous positive airway pressure (CPAP) therapy prevents upper airway obstruction and reverses inflammation. We therefore tested whether CPAP therapy normalized the IR abnormality in OSA. The IR responses of scalene muscles to brief airway occlusion were measured in 37 adult participants with untreated, mostly severe, OSA, of whom 13 were restudied after the initiation of CPAP therapy (usage >4 h/night). Participants received CPAP treatment as standard clinical care, and the mean CPAP usage between initial and subsequent studies was 6.5 h/night (range 4.1-8.8 h/night) for a mean of 19 mo (range 4–41 mo). The duration of the IR in scalene muscles in response to brief (250 ms) inspiratory loading was confirmed to be prolonged in the participants with OSA. The IR was assessed before and after CPAP therapy. CPAP treatment did not normalize the prolonged duration of the IR to airway occlusion (60 ± 21 ms pretreatment vs. 59 ± 18 ms posttreatment, means ± SD) observed in participants with severe OSA. This suggests that the prolongation of IR reflects alterations in the reflex pathway that may be irreversible, or a specific disease trait.

scholarly journals Perioperative Management of Obstructive Sleep Apnea With Nasal Continuous Positive Airway Pressure

2008 ◽  
Vol 55 (4) ◽  
pp. 121-123 ◽  
Author(s):  
Hirofumi Arisaka ◽  
Shigeki Sakuraba ◽  
Reiko Kobayashi ◽  
Homare Kitahama ◽  
Naofumi Nishida ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Perioperative Period ◽  
Obstructive Sleep ◽  
Analgesic Agents

Abstract The high risks associated with general anesthesia in obstructive sleep apnea syndrome (OSAS) patients have been reported. Many authors have suggested that the intraoperative administration of opioids and sedatives should be limited or avoided because these drugs selectively impair muscle activity in the upper airway. We report the case of an OSAS patient who was managed with nasal continuous positive airway pressure (NCPAP) and treated safely in spite of the use of conventional anesthetic and analgesic agents typically used for patients without OSAS. She had little pain during the perioperative period. It is suggested that NCPAP is an effective treatment for not only preventing airway obstructive apnea but for allowing the administration of anesthetic and analgesic drugs without major complications.

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