Detection of Upper Airway Resistance Syndrome Using a Nasal Cannula/Pressure Transducer

Epstein, Marcia; Chicoine, Sheryl A.; Hanumara, R. Choudary

doi:10.1378/chest.117.4.1073

Cited by 49 publications

(22 citation statements)

References 18 publications

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“…upper airway resistance syndrome) not associated with hypoxemia, but which may last for repetitive stretches of several minutes (14,35), there is a progressive lengthening of inspiration (inspiration time) with reduction of expiration (expiratory time) (35). Such repetitive stretches, uninterrupted by arousals as shown in adults and children (12,14,35), should lead to progressively less important MSNA stimulation and let the parasympathetic tone be the main modulator of BP with nonhypoxemic resistive breathing, as shown by Seal et al and St Croix et al (32,33). One may even hypothesize that if resistive breathing, even to a lower degree than during sleep, is present during the daytime, such prominence of vagal tone will be seen during the 24-h period.…”

Section: Discussionmentioning

confidence: 99%

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Abnormal Blood Pressure in Prepubertal Children with Sleep-Disordered Breathing

et al. 2004

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The purpose of this study was to investigate the association between low blood pressure (BP) with mild symptoms of orthostatism, sleep-disordered breathing (SDB) and tilt test results in 7-to 12-y-old children. A retrospective chart review of 301 children, ages 7 to 12 y, was initially performed to evaluate the frequency of abnormal BP measurements. Then a prospective study was performed on 7-to 12-y-old prepubertal children with SDB, looking for both abnormal BP and mild orthostatism. All children had polysomnography. Those identified with abnormal (high or low) BP measurements (called "BP outliers") were studied with a new polysomnogram followed by a head-up tilt test as an indicator of autonomic activity. Four of the children with low BP were treated with nasal continuous positive airway pressure and received a second head-up tilt test 3.5 to 7 mo after starting treatment. The prospective study included 78 children, eight of whom were BP outliers. Seven of these outliers had low BP. Compared with all of the SDB subjects, SDB subjects with low BP and indicators of mild orthostatic hypotension had a significantly higher incidence of craniofacial dysmorphism, symptoms of SDB early in life, chronically cold extremities, and dizziness on standing up ( 2 , p ϭ 0.01 to 0.0001). They had a significantly greater drop in BP without evidence of autonomic neuropathy than all other children on head-up tilt testing (Kruskal-Wallis ANOVA with Bonferroni adjustment, p ϭ 0.001 to 0.0001). However, the normotensive SDB controls also had significantly different BP drops than the normal controls (p ϭ 0.0001). The four children placed on nasal continuous positive airway pressure had a nonsignificant trend toward normalization of tilt test response. SDB in prepubertal children can lead to different abnormal stimulation of the autonomic nervous system, with different impacts on BP. The severity and frequency of oxygen saturation drops during sleep, nonhypoxic increases in respiratory effort, and the duration of abnormal breathing are suspected of playing a role in the difference in autonomic nervous system stimulation. In the early 1990s, clinical evaluations of adults with suspected SDB revealed LBP and signs of orthostatic intolerance. A large-scale study was performed thereafter (1). We concurrently investigated whether a similar association could be found in prepubertal children through a retrospective study, briefly summarized later.Because of the limitations of a retrospective study, a prospective study was planned on newly recruited children, taking into account the retrospective results. The prospective study was aimed at a further investigation of possible abnormal autonomic control in children with hypertension and with LBP and mild symptoms of orthostatic intolerance. A head-up tilt test was planned for 1) hypertensive and LBP Tanner stage 1 (2) children, 7 y and older, with symptoms of orthostatic intolerance and SDB; 2) age, ethnicity, sex, and SDB-matched children with normal systolic and diastolic BP and no clinical ...

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Section: Discussionmentioning

confidence: 99%

“…Abnormal breathing patterns were identified by a fluid-filled sensor the size of an infant feeding tube (1.6 mm diameter) (11,12), pediatric nasal cannula/pressure transducer system (Protec) (12), and oral thermistor. These instruments measured Pes, nasal flow limitation, and mouth breathing, respectively (5).…”

Section: Sdb Polysomnographic Definitionsmentioning

confidence: 99%

Abnormal Blood Pressure in Prepubertal Children with Sleep-Disordered Breathing

et al. 2004

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“…AITTOKALLIO et al [32] emphasised the usefulness of advanced signal processing in classifying different airflow shapes. Furthermore, EPSTEIN et al [33] showed that flattening, detected on a flow signal, provided by a nasal cannula, may be an alternative to invasive oesophageal pressure measurement. Even if a direct effort measurement is not readily available, APAP devices may have sufficient data to perform effective event recognition, by evaluating the severity of the flattening using flow-shape analysis.…”

Section: Discussionmentioning

confidence: 99%

Bench testing of auto-adjusting positive airway pressure devices

Abdenbi¹

2004

European Respiratory Journal

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Continuous positive airway pressure devices are routinely used to treat sleep breathing disorders. Automated devices that adjust the therapeutic pressure have recently been proposed. The utility of such devices is still controversial, as rigorous clinical comparisons are difficult to perform as a result of patient and device differences.The current authors studied automated devices in a respiratory model that was able to mimic upper airway mechanics and to interact with pressure adjustment in a closed loop. Five auto-adjusted devices were submitted to this model, in order to determine their ability to detect respiratory events and adjust pressure accordingly.All apnoeas were suppressed, whilst the reaction to repetitive hypopnoeas was dependent on the airflow shape. In some devices, repetitive hypopnoeas were changed to flow limitation. Artificial snoring caused a pressure increase in four devices, and constant mask leak was not systematically compensated. Only one device did not raise pressure in response to central apnoeas with opened upper airways. These findings show that, in some devices, event classification failed and normal airflow was not fully restored, resulting in elevated residual event indices.In conclusion, this model is useful in order to reproducibly compare diagnostic and therapeutic capacities of commercial devices as a first step, before costly clinical studies.

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“…The inspiratory flow limitation measured by nasal cannula in the identification of hypopneas or upper airway resistance has been evaluated in different studies [8,9,13,15,17,[27][28][29][30][31], but few studies have evaluated this method in patients without the predominance of apnoeas or hypopnoeas versus the oesophageal pressure measurement (or pharyngeal pressure). In two studies with these characteristics, the sensitivity was estimated between 76-88% and the specificity between 77-81%, considering upper airway resistance not associated to arousal [8,27].…”

Section: Discussionmentioning

confidence: 99%

Assessment of thoracoabdominal bands to detect respiratory effort-related arousal

Masa¹,

Corral²,

Martín³

et al. 2003

Eur Respir J

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It would be helpful to be able to identify respiratory effort-related arousal (RERA) without needing to measure oesophageal pressure. Thoracoabdominal movements yield an indirect flow measurement from which reduction of amplitude and alteration of the inspiratory flow curve can be detected. The aim of this study was to evaluate the accuracy of using the shape and amplitude of signals from thoracoabdominal bands (inductance plethysmography) to detect RERAs.Altogether, 94 subjects suspected of having sleep apnoea but with an apnoea/ hypopnoea index f10 in full polysomnography with oesophageal pressure were studied. A routine polysomnographical analysis was carried out. The polysomnographies were then reanalysed at random to determine which of the identified arousals were due to RERA, as determined either by oesophageal pressure or by induction bands without an oesophageal pressure signal. Altogether, 14,617 arousals were analysed.The sensitivity and specificity to find RERA (arousal by arousal) from bands versus oesophageal pressure were both 94%. The average difference of RERA index between oesophageal pressure and bands was -0.6. The correlation between RERA index determined by oesophageal pressure and bands was 0.98. To evaluate the intra and interobserver agreement, 1183 arousals were additionally analysed. The intraobserver agreement was 91% for RERAs by oesophageal pressure and 80% by bands. The interobserver agreement was 89% by oesophageal pressure and 85% by bands.The thoracoabdominal bands can be used to identify respiratory effort-related arousal (obstructive events not detected by thermistor) with similar efficacy to oesophageal pressure measurement. Since bands are routinely used in most polysomnographies, they can be used as the usual method to detect respiratory effort-related arousal, using a thermistor to evaluate apnoeas and hypopnoeas or as a complement to other methods, such as nasal cannula, which can detect apnoeas, hypopnoeas and respiratory effort-related arousal. Eur Respir J 2003; 22: 661-667.

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Detection of Upper Airway Resistance Syndrome Using a Nasal Cannula/Pressure Transducer

Cited by 49 publications

References 18 publications

Abnormal Blood Pressure in Prepubertal Children with Sleep-Disordered Breathing

Abnormal Blood Pressure in Prepubertal Children with Sleep-Disordered Breathing

Bench testing of auto-adjusting positive airway pressure devices

Assessment of thoracoabdominal bands to detect respiratory effort-related arousal

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