An assessment of a simple clinical technique to estimate pharyngeal collapsibility in people with obstructive sleep apnea
- 8 April 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Sleep
- Vol. 43 (10)
- https://doi.org/10.1093/sleep/zsaa067
Abstract
Quantification of upper airway collapsibility in obstructive sleep apnea (OSA) could help inform targeted therapy decisions. However, current techniques are clinically impractical. The primary aim of this study was to assess if a simple, novel technique could be implemented as part of a CPAP titration study to assess pharyngeal collapsibility. 35 participants (15-female) with OSA (mean±SD AHI=35±19events/h) were studied. Participants first completed a simple clinical intervention during a routine CPAP titration where CPAP was transiently turned off from the therapeutic pressure for ≤5 breaths/efforts on ≥5 occasions during stable non-REM sleep for quantitative assessment of airflow responses (%peak inspiratory flow[PIF] from preceding 5 breaths). Participants then underwent an overnight physiology study to determine the pharyngeal critical closing pressure (Pcrit) and repeat transient drops to zero CPAP to assess airflow response reproducibility. Mean PIF of breaths 3-5 during zero CPAP on the simple clinical intervention versus the physiology night were similar (34±29 vs. 28±30% on therapeutic CPAP, p=0.2; range 0-90 vs. 0-95%). Pcrit was -1.0±2.5cmH2O (range -6 to +5cmH2O). Mean PIF during zero CPAP on the simple clinical intervention and the physiology night correlated with Pcrit (r=-0.7 and -0.9 respectively, p2O (AUC=0.81 and 0.92), respectively. A simple CPAP intervention can successfully discriminate between patients with and without mild to moderately collapsible pharyngeal airways. This scalable approach may help select individuals most likely to respond to non-CPAP therapies.Keywords
Funding Information
- Cooperative Research Centre for Alertness, Safety and Productivity
- Australian Research Council (FT120100510)
- National Health and Medical Research Council (1116942, 1139745, 1106974)
This publication has 58 references indexed in Scilit:
- Breath‐holding as a means to estimate the loop gain contribution to obstructive sleep apnoeaJournal Of Physiology-London, 2018
- Quantifying the Arousal Threshold Using Polysomnography in Obstructive Sleep ApneaSleep, 2017
- Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway AnatomySleep Medicine, 2016
- Obstructive sleep apnea and incident type 2 diabetesSleep Medicine, 2016
- Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic TargetsAmerican Journal of Respiratory and Critical Care Medicine, 2013
- Neurocognitive function in obstructive sleep apnoea: A meta‐reviewRespirology, 2012
- High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controlsSleep and Breathing, 2012
- Underdiagnosis of Sleep Apnea Syndrome in U.S. CommunitiesSleep and Breathing, 2002
- Long-term follow-up of untreated patients with sleep apnoea syndromeRespiratory Medicine, 2002
- The Occurrence of Sleep-Disordered Breathing among Middle-Aged AdultsThe New England Journal of Medicine, 1993