Lower body positive pressure increases upper airway collapsibility in healthy subjects

Su, Ming‐Yao; Chiu, Kuo-Liang; Ruttanaumpawan, Pimon; Shiota, Satomi; Yumino, Dai; Redolfi, Stefania; Haight, James S. J.; Bradley, T. Douglas

doi:10.1016/j.resp.2008.03.004

Cited by 99 publications

(73 citation statements)

References 35 publications

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“…24 Finally, in healthy subjects, LBPP increased upper airway collapsibility in proportion to the decrease in LFV and the increase in neck circumference. 25 Taken together, these studies strongly suggest that fluid movement into the neck has anatomical and physiological effects on the upper airway that can predispose to OSA.…”

Section: Fluid Shift and Sleep Apnea Variabilitymentioning

confidence: 85%

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

White

Lyons

Yadollahi

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Overnight rostral fl uid shift from the legs to the neck may narrow the pharynx and contribute to obstructive sleep apnea (OSA) pathogenesis. We hypothesized that night-to-night changes in the apneahypopnea index (AHI) would be associated with changes in overnight rostral fl uid shift. Methods: Twenty-six patients with OSA (AHI ≥ 10) underwent two polysomnograms 14 days apart with measurement of neck and leg fl uid volumes (LFV), neck circumference and upper-airway cross-sectional area before and after sleep. Results: Although mean AHI did not differ between polysomnograms, 35% of patients had a difference in AHI > 10, indicating signifi cant intra-individual variability. There were direct correlations between change in non-rapid-eye movement (NREM), but not REM AHI and change in evening LFV between polysomnograms (r = 0.440, p = 0.036 and r = 0.005, p = 0.982, respectively) and between change in supine, but not non-supine AHI and change in evening LFV (r = 0.483, p = 0.020 and r = 0.269, p = 0.280, respectively). An increase in evening LFV between polysomnograms was associated with a greater overnight decrease in LFV (r = 0.560, p = 0.005) and a greater overnight increase in neck fl uid volume (r = 0.498, p = 0.016). Additionally, a greater overnight increase in neck circumference was associated with a greater overnight increase in neck fl uid volume between polysomnograms (r = 0.453, p = 0.020) and a greater overnight decrease in upperairway cross-sectional area (r = −0.587, p = 0.005). Conclusion: Intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fl uid volume and overnight rostral fl uid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep. S C I E N T I F I C I N V E S T I G AT I O N S BRIEF SUMMARYCurrent Knowledge/Study Rationale: Overnight rostral fl uid shift from the legs to the neck may narrow the upper airway and contribute to obstructive sleep apnea (OSA) pathogenesis. Intra-individual night-tonight variability in OSA severity may relate to night-to-night variations in overnight rostral fl uid shift. Study Impact: This study found that intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fl uid volume and overnight rostral fl uid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep. S everity of obstructive sleep apnea (OSA) can vary considerably from night to night, but the reasons for this are unclear. Previous studies found a change in the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI) greater than 10 in 18% to 65% of patients undergoing polysomnograms (PSGs) on consecutive nights or one month apart. [1][2][3][4] Furthermore, in one study, 50% of patients undergoing consecutive night PSGs met criteria for OSA diagnosis (AHI ≥ 10) on one PSG but not on the other. Few studies have examined the reasons for this AHI variability. While one study found increased variabi...

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Section: Fluid Shift and Sleep Apnea Variabilitymentioning

confidence: 85%

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

White

Lyons

Yadollahi

et al. 2015

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition to these factors, some patients with OSAS may present a decrease in the arousal threshold, which would also lead to hyperventilation, hypocapnia and central and obstructive apnea due to the same reason described above [17,18]. Corroborating with the pathophysiology of OSAS, recent studies have shown that the displacement of fluid from the lower portion of the body to the cervical region when the patient assumes the decubitus, leads to accumulation of fluid around the pharynx and contributes to the collapse of the pharynx [19,20].…”

Section: Pathophysiology Of Osamentioning

confidence: 96%

Mandibular Repositioning Appliance in the Treatment of Obstructive Sleep Apnea Syndrome-Mini Review

Cunha

Guimarães

Simamotto

et al. 2017

JDHODT

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“…This has further been proved by experimental studies using medical antishock trousers (MAST) [26,27]. Organ failures such as heart failure [28], renal failure [29], and other disease conditions such as hypertension [30][31][32], stroke [33,34], pulmonary arterial hypertension [35], and other conditions with potential for luid retention are associated with OSA.…”

Section: Systemic Factors Afecting Upper Airway Structurementioning

confidence: 99%

Obstructive Sleep Apnea: Beyond Obesity

Garg¹,

Srivastava²,

Halekote³

2017

Sleep Apnea - Recent Updates

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Sleep disorders are of growing concern and are a major public health problem. The obstructive sleep apnea (OSA) is the most common among diferent sleep-related breathing disorders (SRBDs). Obesity is a known associated risk factor for the OSA but is not limited to them. OSA is also recognized in nonobese population. The description of OSA in non obese patients in the literature is sparse. The clinical presentation is similar as in obese but has few diferences as far as pathophysiology and polysomnographic features are concerned. The severity of OSA in nonobese has less severe manifestations thus requires early recognition and diferent treatment strategy to prevent mismanagement of these patients.

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Lower body positive pressure increases upper airway collapsibility in healthy subjects

Cited by 99 publications

References 35 publications

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

Mandibular Repositioning Appliance in the Treatment of Obstructive Sleep Apnea Syndrome-Mini Review

Obstructive Sleep Apnea: Beyond Obesity

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