Lack of evidence for diaphragmatic fatigue over the course of the night in obstructive sleep apnoea

Montserrat, Josep M.; Kosmas, Epaminondas; Cosio, Manuel G.; Kimoff, R. John

doi:10.1183/09031936.97.10010133

Cited by 23 publications

(26 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, other recent studies did not find any evidence of diaphragmatic muscle fatigue during sleep apnea. 30,31 The finding of a higher IME in OHS vs OSAS patients and the lack of relationship between PaCO2 and inspiratory muscle function suggests that a reduced IME is not a major determinant of daytime hypoventilation in OHS. Structural muscle changes could also contribute to inspiratory muscle dysfunction in obesity.…”

Section: Discussionmentioning

confidence: 99%

Physiologic correlates of dyspnea in patients with morbid obesity

et al. 2006

View full text Add to dashboard Cite

Objective: Mechanisms of dyspnea in obesity remain unclear. This study was undertaken to determine the relationships between dyspnea and pulmonary function including inspiratory muscle endurance (IME) in morbidly obese patients before bariatric surgery. Research methods and procedures: Fifty-five patients with a mean7s.d. body mass index (BMI) of 49.477.0 kg/m 2 were included. Dyspnea was evaluated by the Baseline Dyspnea Index (BDI; 0-12, 0 ¼ maximal dyspnea). Pulmonary function tests included a plethysmography, maximal inspiratory pressure (PImax) and IME was assessed by the incremental threshold loading test, determining the maximal pressure sustained for 2 min (Plim 2 ) and Plim 2 /PImax ratio. Patients were classified according to their BMI in two groups: BMI p49 (n ¼ 27) and 449 kg/m 2 (n ¼ 28

show abstract

Section: Discussionmentioning

confidence: 99%

Physiologic correlates of dyspnea in patients with morbid obesity

et al. 2006

View full text Add to dashboard Cite

show abstract

“…In keeping with this hypothesis, GRIGGS et al [22] reported a prolonged relaxation rate of inspiratory muscle in patients with sleep apnoea. In contrast, MONTSERRAT et al [21] and CIBELLA et al [24], using the technique of diaphragm EMG frequency analysis, were unable arterial oxygen saturation (Sa,O2). End-expiratory Poes increased gradually over the course of an apnoea.…”

Section: Significance Of the Findingsmentioning

confidence: 94%

“…It is usually considered that, at least during nonrapid eye movement sleep, the respiratory muscles, including the diaphragm, work hard to overcome upper airway resistance based on the observation that Poes swings increase during OSA episodes and fall during arousal [21]. Indeed, some investigators have hypothesised that respiratory muscle fatigue would occur in patients with severe OSA [22,23].…”

Section: Significance Of the Findingsmentioning

confidence: 99%

Neural respiratory drive during apnoeic events in obstructive sleep apnoea

Luo

Hua²,

Jing³

et al. 2007

Eur Respir J

View full text Add to dashboard Cite

For a given neural drive, oesophageal pressure during apnoeic episodes may differ from that during airflow, since inspiratory airflow and increased lung volume both reduce pressure generation. It was, therefore, hypothesised that diaphragm electromyography (EMG) may provide additional data to oesophageal pressure when used for the assessment of neural drive in patients with obstructive sleep apnoea, whose breathing is associated with variable airflow and changes in lung volume.Neural respiratory drive was assessed using diaphragm EMG recorded from multipair oesophageal electrodes in 12 patients with obstructive sleep apnoea. Oesophageal pressure was also recorded.The mean¡SD inspiratory oesophageal pressure swing was 11.0¡3.7 cmH 2 O during wakefulness, 38.2¡15.7 cmH 2 O at the end of the apnoea and reduced to 28.5¡10.4 cmH 2 O at the beginning of arousal. The mean peak inspiratory diaphragm EMG signal was 21.8¡6.5 mV during wakefulness, 38.6¡14.0 mV at the end of the apnoea and further increased to 59.6¡32.0 mV at the beginning of arousal.It was concluded that the pattern of neural drive assessed by oesophageal pressure differs from that measured by diaphragm electromyography during apnoeic events and, therefore, that diaphragm electromyography may be a useful adjunct to measurement of oesophageal pressure for the assessment of neural drive in patients with obstructive sleep apnoea.

show abstract

“…GRIGGS et al [4] have shown that pleural pressure relaxation rates during voluntary sniff maneuvers were prolonged in the morning compared with the preceding night prior to sleep in OSA patients. However, MONTSERRANT et al [5] reported lack of evidence for diaphragmatic fatigue during the night in these patients. They explained that the fatiguing levels of inspiratory effort generated throughout the night did not continue for sufficiently long periods to develop impaired contractility.…”

mentioning

confidence: 85%

“…The chronic overuse of the diaphragm was reported to put OSA subjects at risk of inspiratory muscles fatigue [3]. However, whether diaphragm fatigue actually occurs in OSA patients is still controversial [4][5][6]. GRIGGS et al [4] have shown that pleural pressure relaxation rates during voluntary sniff maneuvers were prolonged in the morning compared with the preceding night prior to sleep in OSA patients.…”

mentioning

confidence: 99%

Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea

Chien¹,

Yt²,

Lee³

et al. 2009

Eur Respir J

View full text Add to dashboard Cite

Repetitive inspiratory effort against an obstructed airway and intermittent hypoxia may be deleterious to the inspiratory muscles in patients with obstructive sleep apnoea (OSA).We investigated muscular dysfunction by comparing the strength, endurance and fatigability of inspiratory muscles and knee extensors in patients with newly diagnosed severe OSA compared with matched controls. The measurements included strength and endurance tests of both muscles, and a fatigue trial with simultaneous surface electromyography of the diaphragm and the vastus lateralis during voluntary contractions and in response to magnetic stimulation. To our knowledge, this is the first investigation to assess peripheral muscle performance in severe OSA patients versus controls.Patients in the OSA group exhibited significantly lower strength and endurance in both muscles than the control group. The fatigue index decreased significantly exclusively in the inspiratory muscles of OSA patients. Magnetic stimulation-evoked compound muscle action potential latencies increased and the amplitudes decreased significantly in the diaphragm, but not in the vastus lateralis after a fatigue test in the OSA group.In conclusion, a significantly lower functional performance was shown for both inspiratory muscles and knee extensors in the OSA group. However, higher fatigability was only seen in the inspiratory muscles of patients with severe OSA.

show abstract

Lack of evidence for diaphragmatic fatigue over the course of the night in obstructive sleep apnoea

Abstract: These findings do not support the development of diaphragmatic fatigue over the course of the night in obstructive sleep apnoea.

Cited by 23 publications

References 20 publications

Physiologic correlates of dyspnea in patients with morbid obesity

Physiologic correlates of dyspnea in patients with morbid obesity

Neural respiratory drive during apnoeic events in obstructive sleep apnoea

Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea

Contact Info

Product

Resources

About