The role of mean inspiratory effort on daytime sleepiness

Pelin, Zerrin; Karadeniz, Derya; Öztürk, Levent; Gözükırmızı, Erbil; Kaynak, Hakan

doi:10.1183/09031936.03.00298903

Cited by 29 publications

(22 citation statements)

References 46 publications

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“…In addition, in the eucapnic patients, perturbations in their sleep study results correlated with abnormalities in their WOB. These results are consistent with the findings of Pelin et al [29], who demonstrated a significant correlation between inspiratory effort and daytime sleepiness in OSAS. It appears from our study that the greater workload (both restrictive and elastic) required during sleep of both eucapnic nonobese and obese subjects contributes to their sleep-disordered breathing.…”

Section: Discussionsupporting

confidence: 83%

Work of Breathing in Eucapnic and Hypercapnic Sleep Apnea Syndrome

et al. 2008

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Background: Upper airways in patients with obstructive sleep apnea syndrome (OSAS) are more likely narrower than those of normal subjects, a factor in increasing the work of breathing (WOB) in these individuals. Objectives: To evaluate WOB while sitting and while supine, both awake and during stage 2 sleep, in patients with hypercapnic or eucapnic OSAS. Method: Twenty normal control subjects without OSAS, 20 patients with eucapnic moderate or severe OSAS and another 8 patients with hypercapnic severe OSAS were studied. WOB was measured by esophageal manometry with the subjects seated and then with the subjects supine, both while awake and during stage 2 sleep. Results: In both the control and the eucapnic group, WOB was normal in the sitting position. When the eucapnic subjects lay supine, their WOB increased, both while awake and asleep. In contrast, the hypercapnic subjects had an abnormally high WOB both sitting and supine, whether awake or asleep. Conclusion: WOB was increased in subjects with hypercapnic OSAS in both the sitting and supine positions. While eucapnic individuals with OSAS have increased WOB when supine, it is normal when they are sitting upright.

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Section: Discussionsupporting

confidence: 83%

Work of Breathing in Eucapnic and Hypercapnic Sleep Apnea Syndrome

et al. 2008

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“…Our work has the major advantage over previous investigations in that we included patients with a wide spectrum of OSA severity. Previous studies in predominantly severe patients with OSA have reported modest univariate correlations between the non-REM ArTH and the AHI (13,14,20) and other markers of OSA severity including the minimum Sp O 2 and ArI (13) and the ESS (21). Taken together, these findings suggest that the ArTH is strongly related to severity of disease, which is consistent with our physiologic understanding.…”

Section: Original Articlesupporting

confidence: 80%

“…Non-REM and REM ArTHs were strongly correlated (r 2 = 0.81; P , 0.001). On average, the overall ArTH measurements were derived from 3 (2-5) events (arousals) in control subjects and 20 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) events in the patients with OSA. Figure 2 shows the proportion of control subjects and patients with OSA that had a low overall ArTH; most control subjects had a low ArTH, whereas approximately half of the patients with OSA had a low ArTH (P = 0.005).…”

Section: Resultsmentioning

confidence: 99%

“…Thus, we cannot determine whether the epiglottic pressure before arousal is altered by sleeping in the lateral position. Although the lateral position is often associated with an improvement in OSA severity (36), a previous study reported no positiondependent changes in respiratory effort before arousal (within the same sleep stage) (21). Thus, position is unlikely to affect the ArTH.…”

Section: Methodsologic Considerationsmentioning

confidence: 99%

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Clinical Predictors of the Respiratory Arousal Threshold in Patients with Obstructive Sleep Apnea

Edwards

Eckert

McSharry

et al. 2014

Am J Respir Crit Care Med

234

216

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Rationale: A low respiratory arousal threshold (ArTH) is one of several traits involved in obstructive sleep apnea pathogenesis and may be a therapeutic target; however, there is no simple way to identify patients without invasive measurements.Objectives: To determine the physiologic determinates of the ArTH and develop a clinical tool that can identify patients with low ArTH.Methods: Anthropometric data were collected in 146 participants who underwent overnight polysomnography with an epiglottic catheter to measure the ArTH (nadir epiglottic pressure before arousal). The ArTH was measured from up to 20 non-REM and REM respiratory events selected randomly. Multiple linear regression was used to determine the independent predictors of the ArTH. Logistic regression was used to develop a clinical scoring system.Measurements and Main Results: Nadir oxygen saturation as measured by pulse oximetry, apnea-hypopnea index, and the fraction of events that were hypopneas (F hypopneas ) were independent predictors of the ArTH (r 2 = 0.59; P , 0.001). Using this information, we used receiver operating characteristic analysis and logistic regression to develop a clinical score to predict a low ArTH, which allocated a score of 1 to each criterion that was satisfied: (apnea-hypopnea index, ,30 events per hour) 1 (nadir oxygen saturation as measured by pulse oximetry .82.5%) 1 (F hypopneas .58.3%). A score of 2 or above correctly predicted a low arousal threshold in 84.1% of participants with a sensitivity of 80.4% and a specificity of 88.0%, a finding that was confirmed using leaveone-out cross-validation analysis.Conclusions: Our results demonstrate that individuals with a low ArTH can be identified from standard, clinically available variables. This finding could facilitate larger interventional studies targeting the ArTH.Keywords: sleep apnea; respiratory-induced arousals; arousal threshold; phenotype traits; lung Obstructive sleep apnea (OSA) is a common disease with major neurocognitive and cardiovascular sequelae (1-3). Despite its high prevalence and well-recognized consequences, treatment of OSA remains unsatisfactory because of poor adherence (e.g., continuous positive airway pressure) and variable efficacy of existing therapies (e.g., surgery, oral appliances) (4), creating a need for further research into underlying mechanisms to identify new therapeutic targets.

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“…(UARS). 17 ESS was significantly correlated with the average maximum Pes (oesophageal pressure) in both Obstructive sleep apnea syndrome and Upper airway resistance syndrome patients. However, no significant correlation was found between the MSLT score and average Pes in both Obstructive sleep apnea syndrome and Upper airway resistance syndrome patients.…”

Section: Discussionmentioning

confidence: 89%

Upper airway resistance syndrome: evaluation of patients with excessive day time sleepiness non-invasively

Ingle

2017

Int J Res Med Sci

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Background: Upper airway resistance syndrome (UARS) is a recent concept introduced among sleep disordered breathing (chronic snoring and Obstructive sleep apnea) disorders. UARS also presents with excessive daytime sleepiness (EDS), which is associated with impaired social functioning, work performance and driving ability. However, UARS is not merely a continuum between chronic snoring and obstructive sleep apnea (OSA). Not only UARS patients have equal gender distribution and thin body habitus but they also do not fulfil Polysomnographic criteria of OSA. UARS diagnosis requires oesophageal manometry for diagnosing increased respiratory efforts against increased upper airway resistance (without complete cessation of airflow or hypoxia) and correlating it with EEG arousals to mark an event. Oesophageal manometry is invasive and uncomfortable, therefore, non-invasive means are desirable for evaluation of UARS. The aim of the study is to evaluate the patients with EDS for UARS non-invasively.Methods: 25 consecutive patients with EDS (Epworth Sleepiness Score >9) visiting sleep clinic at a tertiary level hospital in North India were enrolled after informed consent. It was a non-blinded, interventional trial. All enrolled patients underwent nocturnal polysomnography using VIASYS healthcare sleep screen apnea screen cardio polysomnography machine. After PSG, those patients satisfying criteria for OSA were not analysed further. In remaining patients, greater than 10 alpha EEG arousals/h (Spontaneous Arousals) along with flattening or plateau of inspiratory flow contour (by nasal cannula) was employed to diagnose UARS non-invasively. Epi-info software was used in statistical analysis.Results: Out of 25 patients with EDS, 60% (15) were diagnosed as OSA based on Apnea-Hypopnea Index (AHI) > 10/hr. Among 15 OSA patients,10 patients had severe (AHI >30); 2 had moderate (AHI 15-30) and 3 had mild OSAS (AHI 10-15). Only one patient was provisionally diagnosed as UARS based on nasal air flow graph and spontaneous arousals/hr >10.Conclusions: Upper airway resistance syndrome (UARS) is a distinct sleep disorder from obstructive sleep apnea syndrome (OSAS) with unique pathophysiology and it need be evaluated in all patients with unexplained arousals.

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The role of mean inspiratory effort on daytime sleepiness

Cited by 29 publications

References 46 publications

Work of Breathing in Eucapnic and Hypercapnic Sleep Apnea Syndrome

Work of Breathing in Eucapnic and Hypercapnic Sleep Apnea Syndrome

Clinical Predictors of the Respiratory Arousal Threshold in Patients with Obstructive Sleep Apnea

Upper airway resistance syndrome: evaluation of patients with excessive day time sleepiness non-invasively

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