Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy

Author(s)

Hirata, Raquel P. ; Schorr, Fabiola ; Kayamori, Fabiane ; Moriya, Henrique Takachi ; Romano, Salvatore ; Insalaco, Giuseppe ; Gebrim, Eloisa M. ; Franco de Oliveira, Luis Vicente ; Genta, Pedro R. ; Lorenzi-Filho, Geraldo

• Document type: Journal article
• Source: JOURNAL OF CLINICAL SLEEP MEDICINE; v. 12, n. 10, p. 1339-1346, 2016.
• Web of Science Citations: 8

Abstract

Study Objectives: There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness. We hypothesized that NEP will be, similarly to Pcrit, associated with upper airway anatomy assessed by computed tomography (CT) scan. Methods: Patients under investigation for OSA underwent polysomnography, CT of the upper airway, NEP while awake, and Pcrit during sleep. NEP was performed with -5 cm H2O in supine position using a nasal mask. Pcrit was measured during sleep induced by low doses of midazolam. Results: Twenty-eight male subjects were studied (age 45 +/- 13 y, body mass index 29.4 +/- 4.9 kg/m(2), apnea-hypopnea index (AHI) 30 +/- 26, range 2 to 86 events/ h). NEP and Pcrit were similarly associated with tongue area (r = 0.646 and r = 0.585), tongue volume (r = 0.565 and r = 0.613) and pharyngeal length (r = 0.580 and r = 0.611), respectively (p < 0.05 for all comparisons). NEP and Pcrit were also significantly correlated with AHI (r = 0.490 and r = 0.531). NEP and Pcrit were significantly higher in patients with severe OSA than the remaining population. Conclusions: NEP is a simple and promising method that is associated with the anatomical component of upper airway collapsibility. NEP may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA. (AU)

• FAPESP's process: 11/12120-5 - Effects of oropharyngeal exercises on snoring intensity, symptoms, upper airway anatomy and colapsability of upper airways awake and asleep in patients with primary snoring and mild to moderate obstructive sleep apnea
• Grantee: Geraldo Lorenzi Filho
• Support Opportunities: Regular Research Grants
• FAPESP's process: 12/20743-5 - UPPER AIRWAY COLLAPSIBILITY TRHOUGH THE CRITICAL CLOSING PRESSURE TECHNIQUE DURING SLEEP AND THE NEGATIVE EXPIRATORY PRESSURE TEST DURING WAKEFULNESS AND SLEEP IN OBSTRUCTIVE SLEEP APNEA AND NORMAL SUBJECTS.
• Grantee: Raquel Pastréllo Hirata
• Support Opportunities: Scholarships in Brazil - Doctorate