Study objectives: Obstructive sleep apnea (OSA) is defined by pauses in breathing during sleep, but daytime breathing dysregulation may also be present. Sleep may unmask breathing instability in OSA that is usually masked by behavioral influences during wakefulness. A breath-hold (BH) challenge has been used earlier to demonstrate breathing instability. One measure of breathing stability is breathing rate variability (BRV). We aimed to assess BRV during rest and in response to BH in OSA.Methods. We studied 62 participants (31 untreated OSA: Respiratory Event Index (REI) [mean±s.d.] 20±15 events/hour, 12 females, age 51±14years, BMI 32±8kg/m 2 ; 31 control: 17 females, age 47±13; BMI 26±4). Breathing movements were collected using a chest belt for 5 minutes rest and during a BH protocol (60 s baseline, 30 s BH, 90 s recovery, 3 repeats). From the breathing movements, we calculated median breathing rate (BR) and interquartile BRV at rest. We calculated change in BRV during BH recovery from baseline. Group comparisons of OSA vs. control were conducted using analysis of covariance (ANCOVA) with age, sex and BMI as covariates.Results. We found 10% higher BRV in OSA vs. control (p<0.05) during rest. In response to BH, BRV increased 7% in OSA vs. 1% in controls (p<0.001). Resting BR was not significantly different in OSA and control, and sex and age did not have any significant interaction effects. BMI was associated with BR at rest (p<0.05) and change in BRV with BH (p<0.001), but no significant BMI-by-group interaction effect was observed.
Conclusions.The findings suggest breathing instability as reflected by BRV is high in OSA during wakefulness, both at rest and in response to a stimulus. Breathing instability together with high blood pressure variability in OSA may reflect a compromised cardiorespiratory consequence in OSA during wakefulness.