Effects of Nasal Continuous Positive Airway Pressure on Awake Ventilatory Responses to Hypoxia and Hypercapnia in Patients with Obstructive Sleep Apnea

Tun, Ye; Hida, Wataru; Okabe, Shinichi; Kikuchi, Yoshihiro; Kurosawa, Hájíme; Tabata, Masao; Shirato, Kunio

doi:10.1620/tjem.190.157

Cited by 25 publications

(15 citation statements)

References 17 publications

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“…Previously, we observed that OSA patients with chronic hypercapnia had a lower ventilatory response to hypercapnia, which was improved to a normal level after nasal CPAP. 23 In the present study, although we did not examine the chemosensitivity, we speculate that the hypercapnic ventilatory response in OHS patients may be lower than that in obese OSA patients, as reported by previous investigators. [24][25][26] Recently, it was reported that obese hypercapnic patients had higher fasting serum leptin levels than eucapnic patients, and serum leptin was a better predictor than body fat for the presence of hypercapnia.…”

Section: Discussionsupporting

confidence: 61%

Nasal Continuous Positive Airway Pressure Improves Quality of Life in Obesity Hypoventilation Syndrome

et al. 2003

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We studied the quality of life of obesity hypoventilation syndrome (OHS) by comparing it with age- and body mass index-matched patients without hypoventilation and age-matched obstructive sleep apnea (OSA) patients with body mass index (BMI) under 30, and the efficacy of nasal continuous positive airway pressure (CPAP) therapy for 3 to 6 months on the quality of life in these patients. Prospectively recruited patients from six sleep laboratories in Japan were administered assessments of the general health status by the Short-Form 36 Health Survey (SF-36) and subjective sleepiness by the Epworth Sleepiness Scale (ESS). Compared with matched healthy subjects, OHS and OSA patients not yet treated had worse results on the ESS scores and the SF-36 subscales for physical functioning, role limitations due to physical problems, general health perception, energy/vitality, role limitations due to emotional problems, and social functioning. The ESS scores of OHS patients were worse than those of the OSA groups including the age- and BMI-matched OSA patients. In the SF-36 subscales of OHS patients, only the subscale of social functioning showed worse results compared with that of BMI-matched OSA patients. After 3 to 6 months of treatment, ESS scores and these SF-36 subscales in all three patient groups improved to the normal level. These results suggested that the quality of life of OHS before nasal CPAP was significantly impaired and that nasal CPAP for OHS improved the quality of life associated with the improvement of daytime sleepiness to the level of the other OSA patients.

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Section: Discussionsupporting

confidence: 61%

Nasal Continuous Positive Airway Pressure Improves Quality of Life in Obesity Hypoventilation Syndrome

et al. 2003

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“…Using magnetic resonance spectroscopy, Kamba and colleagues revealed metabolic changes in brain tissue of patients with sleep apnea (28). Likewise, studies have demonstrated that treatment with nasal CPAP resulted in changes in the ventilatory response to CO 2 and O 2 (29,30) and reversal of impaired load compensation after 2 to 4 weeks of nasal CPAP therapy (31). Finally, in a recent study, Loewen and colleagues found that the dynamic ventilatory responses to combined hypoxia and hypercapnia decrease with 5 months of CPAP use in a group of subjects with severe OSA, indicating that OSA is associated with reversible changes in peripheral chemoresponsiveness (32).…”

Section: Mechanisms Of Increased Controller Gain In Patients With Osamentioning

confidence: 99%

Increased Propensity for Central Apnea in Patients with Obstructive Sleep Apnea

Salloum¹,

Rowley²,

Mateika³

et al. 2010

Am J Respir Crit Care Med

167

112

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Rationale: There is increasing evidence of increased ventilatory instability in patients with obstructive sleep apnea (OSA), but previous investigations have not studied whether the hypocapnic apneic threshold is altered in this group. Objectives: To compare the apneic threshold, CO 2 reserve, and controller gain between subjects with and without OSA matched for age, sex, and body mass index. Methods: Hypocapnia was induced via nasal mechanical ventilation for 3 minutes. Cessation of mechanical ventilation resulted in hypocapnic central hypopnea or apnea depending upon the magnitude of the hypocapnia. The apnea threshold (PET CO 2 -AT) was defined as the measured PET CO 2 at which the apnea closest to the last hypopnea occurred. The CO 2 reserve was defined as the change in PET CO 2 between eupneic PET CO 2 and PET CO 2 -AT. Controller gain was defined as the ratio of change in VE between control and hypopnea or apnea to the DPET CO 2 . Measurements and Main Results: Eleven pairs of subjects were studied. There was no difference in the PET CO 2 -AT between the two groups. However, the CO 2 reserve was smaller in the subjects with OSA (2.2 6 0.6 mm Hg) compared with the control subjects (4.5 6 1.4 mm Hg; P , 0.001). The controller gain was increased in the subjects with OSA (3.7 6 1.3 L/min/mm Hg) compared with the control subjects (1.6 6 0.5 L/min/mm Hg; P , 0.001). Controller gain decreased and CO 2 reserve increased in seven subjects restudied after using continuous positive airway pressure for 1 month. Conclusions: Ventilatory instability is increased in subjects with OSA and is reversible with the use of continuous positive airway pressure.

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“…Before the sleep study, the ventilatory tests were performed (Tun et al 2000). Measurements were started several minutes after a steady state had been achieved, as evidenced by the finding of a stable end-tidal partial CO 2 pressure.…”

Section: Ventilatory Response Tests To Carbon Dioxidementioning

confidence: 99%

End-Tidal CO<sub>2</sub> Tension Is Predictive of Effective Nocturnal Oxygen Therapy in Patients with Chronic Heart Failure and Central Sleep Apnea

Sugimura

Shinozaki

Fukui

et al. 2016

Tohoku J. Exp. Med.

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Central sleep apnea (CSA) is characterized by recurring cycles of crescendo-decrescendo ventilation during sleep, and enhances sympathetic nerve activity. Thus CSA has a prognostic impact in patients with chronic heart failure (CHF). Although nocturnal oxygen (O 2 ) therapy decreases frequency of CSA and improves functional exercise capacity, it is also known that some non-responders to the therapy exist. We thus aimed to identify predictors of responders to nocturnal O 2 therapy in CHF patients with CSA. In 12 CHF patients with CSA hospitalized at our department, sleep study was performed at 2 consecutive nights. Patients nasally inhaled O 2 at either the first or second night in a randomized manner. To predict the percentage reduction in apnea-hypopnea index (%ΔAHI) in response to the nocturnal O 2 therapy, we performed multiple regression analysis with a stepwise method with variables including age, brainnatriuretic peptide, circulation time, baseline AHI, hypercapnic ventilatory response and end-tidal carbon dioxide tension (P ET CO 2 ). Nocturnal O 2 therapy significantly decreased AHI (from 32 ± 13 /h to 12 ± 10 /h, P < 0.0001). Among the possible predictors, P ET CO 2 was the only variable that is predictive of % changes in AHI. Receiver operating characteristics analysis determined 4.25% as the optimal cutoff P ET CO 2 level to identify responder to nocturnal O 2 therapy (> 50% reduction of AHI), with 88.9% of sensitivity and 66.7% of specificity. In conclusion, P ET CO 2 is useful to predict the efficacy of O 2 therapy in CHF patients with CSA, providing important information to the current nocturnal O 2 therapy.

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Effects of Nasal Continuous Positive Airway Pressure on Awake Ventilatory Responses to Hypoxia and Hypercapnia in Patients with Obstructive Sleep Apnea

Cited by 25 publications

References 17 publications

Nasal Continuous Positive Airway Pressure Improves Quality of Life in Obesity Hypoventilation Syndrome

Nasal Continuous Positive Airway Pressure Improves Quality of Life in Obesity Hypoventilation Syndrome

Increased Propensity for Central Apnea in Patients with Obstructive Sleep Apnea

End-Tidal CO<sub>2</sub> Tension Is Predictive of Effective Nocturnal Oxygen Therapy in Patients with Chronic Heart Failure and Central Sleep Apnea

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