Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects.

Abstract

Sleep deprivation can induce or worsen nocturnal respiratory disturbances. In patients with sleep apnea hypopnea, sleep abnormalities consist of repetitive episodes of arousals and awakenings that lead to sleep fragmentation. Because the propensity for upper airway collapse is increased in these patients, we wondered if sleep fragmentation could increase upper airway collapsibility and contribute to the pathogenesis of this disease. In eight normal subjects, upper airway collapsibility was assessed during sleep by progressively decreasing the pressure in a nasal mask while recording airflow, mask, and esophageal pressures. The critical pressure was determined by the relationship between breath-by-breath values of maximal inspiratory airflow of each flow-limited inspiratory cycle and the corresponding mask pressure. Critical pressure was measured twice in each subject: after one night of total sleep deprivation and after one night of sleep fragmentation using auditory stimuli. The two measures were done in random order 1 wk apart. A polysomnographic recording was obtained the night after each measurement of critical pressure. Sleep architecture was identical after sleep deprivation and fragmentation. Sleep-related breathing abnormalities were more frequent after sleep fragmentation than after sleep deprivation. Critical pressure was -17.1 +/- 6.8 cm H2O (mean +/- SEM) after sleep deprivation, and -12.3 +/- 6.3 cm H2O after sleep fragmentation (p < 0.05), corresponding to an earlier closing of the upper airway. We conclude that sleep fragmentation leads to a higher upper airway collapsibility than does sleep deprivation.

Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea

“…This has been noted in previous diurnal diagnostic studies and is usually explained by the effects of sleep deprivation [24][25][26]. However, the patients in this study were not sleep deprived.…”

Where There Is Smoke…There Is Sleep Apnea

“…It is not clear which factors in this study diff ered from previous ones, but in this study, previous exposure to smoking was associated with worsening OSA. 26 Several studies found an association between smoking and self-reported sleep quality. Two studies used comprehensive sleep and health questionnaires to assess sleep quality.…”

“…39 Infants exposed to maternal smoking have reduced spontaneous and evoked arousability from sleep, again suggesting that the arousal threshold is impaired with exposure to smoke. 40 , 41 Although the higher arousal threshold (and therefore reduction in arousals) may result in less sleep instability and decreased upper airways collapsibility, 26 there may still be an eff ect on OSA. In a previously cited study of 1,492 adults referred for sleep evaluation, subjects who currently smoked exhibited a higher overall arousal index, but yet, during episodes of upper airways collapse, events were longer and desaturations were greater.…”

Compliance in sleep apnoea therapy: influence of home care support and pressure mode

“…One possible explanation for such an effect is the reduction of mucosal oedema by minimising vibrational trauma, which is known to account for upper airway collapsibility, in part [26]. Another possible explanation is a reduction in sleep fragmentation, reflected by a further decrease in the arousalindex in the present study; sleep fragmentation is known to increase upper airway collapsibility [27,28]. A decrease in daytime somnolence may also be due to a better acclimatisation to CPAP and therefore less sleep fragmentation.…”