Influence of interface and position on upper airway collapsibility assessed by negative expiratory pressure

Author(s)

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

• Document type: Journal article
• Source: Sleep and Breathing; v. 21, n. 3, p. 631-638, SEP 2017.
• Web of Science Citations: 0

Abstract

Purpose Negative expiratory pressure (NEP) is a simple technique for the evaluation of upper airway collapsibility in patients with obstructive sleep apnea (OSA). Most studies evaluated NEP using a mouthpiece that may exclude the cephalic portion of the upper airway. We hypothesize that NEP determination is influenced by interface and position. Methods We evaluated patients with suspected OSA using polysomnography, NEP (-5 cmH(2)O in sitting and supine position with mouthpiece and nasal mask). A subgroup also underwent computed tomography (CT) of the upper airway. Results We studied a total of 86 subjects (72 male, age 46 +/- 12 yrs, body mass index 30.0 +/- 4.4 kg/m(2), neck circumference 40.0 +/- 3.5 cm, AHI 32.9 +/- 26.4, range 0.5 to 122.5 events/hour). NEP was influenced by interface and position (p = 0.007), and upper airwaywas more collapsible with mouthpiece than with nasal mask in sitting position (p = 0.001). Position influenced NEP and was worse in supine only when evaluated by nasal mask. Expiratory resistance (R-0.2) at 0.2 s during NEP was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 versus 8.6 cmH(2)O/L s(-1), respectively, p = 0.018). NEP evaluated with nasal mask in supine position and with mouthpiece in sitting position, but not when evaluated with mouthpiece in supine position, were correlated with upper airway anatomical measurements including tongue dimensions and pharyngeal length. Conclusions Interface and position influence NEP. NEP evaluated with nasal mask in supine position may convey more relevant information for patients under investigation for OSA than when evaluated with mouthpiece. (AU)

• 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
• 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