Expiratory Pharyngeal Narrowing during Central Hypocapnic Hypopnea

Sankri-Tarbichi, Abdul Ghani; Rowley, James A.; Badr, M. Safwan

doi:10.1164/rccm.200805-741oc

Cited by 71 publications

(50 citation statements)

References 29 publications

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“…In one study [13], electromyogram recordings demonstrated that pharyngeal constrictors were inactive, suggesting passive airway closure. In addition, SANKRI-TARBICHI et al [14] and BADR et al [15] observed diminished pharyngeal cross-sectional area on video-endoscopy associated with increased upper airway resistance during induced central hypocapnic hypopnoea. Of note, retropalatal narrowing under these low drive/hypotonic conditions occurred predominantly during the expiratory phase [14].…”

Section: Discussionmentioning

confidence: 97%

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Evaluation of upper airway patency during Cheyne–Stokes breathing in heart failure patients

et al. 2012

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Little is known about the changes in upper airway calibre in Cheyne-Stokes respiration (CSR) during sleep in patients with congestive heart failure. This study aimed to test the hypothesis that upper airway closure occurs during central CSR events, by assessing upper airway calibre during sleep using the forced oscillation technique (FOT).Nine males with compensated heart failure (left ventricular ejection fraction mean¡SEM 27.9¡5.1%) and predominant central CSR (apnoea/hypopnoea index 43.9¡4.2 events?h -1 ) were studied during overnight polysomnography, which included pneumotachography, inductance plethysmography or oesophageal pressure and FOT-derived impedance signal (|Z|).Baseline Increases in |Z| consistent with upper airway narrowing (more than two-fold baseline) were common during central apnoeas (50¡12% of events) occurring in the middle or end of apnoeas and occurred during some central hypopnoeas (16¡10% of events), typically in the expiratory phase. These findings indicate that in heart failure patients, reductions in upper airway calibre are common during CSR apnoeas, and may also occur during central hypopnoeas.

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Section: Discussionmentioning

confidence: 97%

“…Upper airway closure has previously been reported to occur in some forms of both spontaneous and experimentally induced central apnoea [7,[12][13][14][15].…”

mentioning

confidence: 99%

Evaluation of upper airway patency during Cheyne–Stokes breathing in heart failure patients

et al. 2012

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“…c) the airway can close during polysomnographic central apnea; (Badr 1996;Badr et al 1995) d) central hypopneas demonstrate flow-limitation (Badr et al 1995;Sankri-Tarbichi et al 2009;Guilleminault et al 1997;Dowdell et al 1990). Despite the known presence of flow limitation and airway narrowing during both central and obstructive events (Dempsey et al 2014), hypopnea scoring is biased towards obstructive disease (Rao & Thomas 2013;Eckert et al 2007;Javaheri & Dempsey 2013).…”

Section: Accurate Estimation Of Central Sleep Apnea From Clinical Polmentioning

confidence: 99%

Distinct polysomnographic and ECG-spectrographic phenotypes embedded within obstructive sleep apnea

Thomas

Shin

Bianchi

et al. 2017

Sleep Science Practice

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Background: The primary metric extracted from the polysomnogram in patients with sleep apnea is the apnea-hypopnea index (or respiratory disturbance index) and its derivatives. Other phenomena of possible importance such as periods of stable breathing, features suggestive of high respiratory control loop gain, and sleep fragmentation phenotypes are not commonly generated in clinical practice or research. A broader phenotype designation can provide insights into biological processes, and possibly clinical therapy outcome effects. Methods: The dataset used for this study was the archived baseline diagnostic polysomnograms from the Apnea Positive Pressure Long-term Efficacy Study (APPLES). The electrocardiogram (ECG)-derived cardiopulmonary coupling sleep spectrogram was computed from the polysomnogram. Sleep fragmentation phenotypes used thresholds of sleep efficiency (SE) ≤ 70%, non-rapid eye movement (NREM) sleep N1 ≥ 30%, wake after sleep onset (WASO) ≥ 60 min, and high frequency coupling (HFC) on the ECG-spectrogram ≤ 30%. Sleep consolidation phenotypes used thresholds of SE ≥ 90%, WASO ≤ 30 min, HFC ≥ 50% and N1 ≤ 10%. Multiple and logistic regression analysis explored cross-sectional associations with covariates and across phenotype categories. NREM vs. REM dominant apnea categories were identified when the NREM divided by REM respiratory disturbance index (RDI) was > 1. Results: The data was binned first into mild, moderate, severe and extreme categories based on the respiratory disturbance index of < 10, 10-30, 30-60, and greater than 60, per hour of sleep. Using these criteria, 70, 394, 320 and 188 for polysomnogram, and 54, 296, 209 and 112 subjects for ECG-spectrogram analysis groups. All phenotypes were seen at all severity levels. There was a higher correlation of NREM-RDI with the amount of ECG-spectrogram narrow band coupling, vs. REM-RDI, 0.41 vs 0.14, respectively. NREM dominance was associated with male gender and higher mixed/central apnea indices. Absence of the ECG-spectrogram sleep consolidated phenotype was associated with an increased odds of being on antihypertensive medications, OR 2.65 [CI: 1.64-4.26], p = < 0.001. Conclusions: Distinct phenotypes are readily seen at all severities of sleep apnea, and can be identified from conventional polysomnography. The ECG-spectrogram analysis provides further phenotypic differentiation.

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“…Narrowing of the pharynx on expiration occurs during central hipocapnic hypopnea, supporting the concept that the presence of flow limitation by itself cannot be used to distinguish between obstructive and central hypopnea. [18][19][20] We consider that scoring central and mixed events in polysomnography is important not only in the baseline assessment of sleep-related breathing disorders, but it should also be taken into account by the criteria used to estimate the therapies success.…”

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confidence: 99%

Obstructive Sleep Apnea and Oral Appliances

Guimarães¹,

Hermont²

2017

Epidemiol Open J

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Expiratory Pharyngeal Narrowing during Central Hypocapnic Hypopnea

Abstract: Expiratory pharyngeal narrowing occurs during central hypocapnic hypopnea. Reduced ventilatory drive leads to increased expiratory, but not inspiratory, upper airway resistance. Central hypopneas are obstructive events because they cause pharyngeal narrowing.

Cited by 71 publications

References 29 publications

Evaluation of upper airway patency during Cheyne–Stokes breathing in heart failure patients

Evaluation of upper airway patency during Cheyne–Stokes breathing in heart failure patients

Distinct polysomnographic and ECG-spectrographic phenotypes embedded within obstructive sleep apnea

Obstructive Sleep Apnea and Oral Appliances

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