Esophageal pressure and apnea hypopnea index in sleep‐disordered breathing

Watanabe, Takuya; Mikami, Akira; Shigedo, Yoshihisa; Motonishi, Masamichi; Honda, Hirotsugu; Kyotani, Kyoko; Uruha, Shigehiko; Terashima, Kiyoji; Teshima, Yoshio; Sugita, Yoshiro; Takeda, Masatoshi

doi:10.1046/j.1440-1819.2000.00704.x

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…The increases in negative intrathoracic pressure caused by inspiratory efforts are thought to play an important role in the pathophysiology of sleep-disordered breathing (SDB) [1] . It has been proven that the role of inspiratory effort in obstructive respiratory events includes arousal [2,3] , and hemodynamic [4] or endocrine consequences [5] , and the degree of inspiratory effort correlates with the severity of hemodynamic changes [6,7] (e.g.…”

Section: Introductionmentioning

confidence: 99%

Pulse Transit Time for Quantifying Inspiratory Effort in Patients with Obstructive Sleep Apnea

Huang

Ye²,

Li³

et al. 2011

ORL

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Objectives: To investigate the feasibility of pulse transit time (PTT) as a quantitative measure of inspiratory effort in patients with obstructive sleep apnea (OSA). Methods: Nineteen moderate to severe OSA patients were included to undergo overnight polysomnography simultaneously with esophageal pressure (P_es) and PTT. The quantitative relationships between the size of P_es variations (ΔP_es) and PTT variations (ΔPTT) on a breath-by-breath basis in obstructive apneas were assessed. Results: A total of 19,833 breaths from 6,087 obstructive apneas were analyzed. There were good correlations with r = 0.779 ± 0.095 (mean ± SD) between ΔP_es and ΔPTT based on overnight sleep. The correlation coefficients for supine and lateral position were of the approximated magnitude (r = 0.783 ± 0.060 and 0.757 ± 0.106, respectively), whereas they were lower in rapid eye movement (REM) sleep (r = 0.564 ± 0.140) compared with non-rapid eye movement (NREM) sleep (r = 0.787 ± 0.071). In NREM sleep, the regression lines of ΔPTT against ΔP_es were plotted with intercepts (5.1 ± 2.1 ms) and slopes (0.35 ± 0.08 ms·cm H₂O^–1). Conclusions: PTT showed good ability in detecting changes of inspiratory effort in overnight sleep and was proved to be a clinically useful method in quantifying increases in inspiratory effort in NREM sleep. Hence, PTT has prospects to become an alternative to P_es in respiratory sleep studies.

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Section: Introductionmentioning

confidence: 99%

Pulse Transit Time for Quantifying Inspiratory Effort in Patients with Obstructive Sleep Apnea

Huang

Ye²,

Li³

et al. 2011

ORL

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“…A total of 46 study subjects were enrolled in the study following informed consent, including nineteen subjects with untreated OSA (i.e., not on airways therapy) and nineteen treated OSA individuals, who were diagnosed by polysomnography using the Apnea Hypopnea Index (AHI) (Table 1 ) [ 101 , 102 ]. The airway-treated OSA subjects recorded using primary CPAP, except for one patient who used a dental airways device, and both devices had been employed for more than 6 months [ 22 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

Patients with obstructive sleep apnea have suppressed levels of soluble cytokine receptors involved in neurodegenerative disease, but normal levels with airways therapy

et al. 2020

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Purpose Obstructive sleep apnea (OSA) results in systemic intermittent hypoxia. By one model, hypoxic stress signaling in OSA patients alters the levels of inflammatory soluble cytokines TNF and IL6, damages the blood brain barrier, and activates microglial targeting of neuronal cell death to increase the risk of neurodegenerative disorders and other diseases. However, it is not yet clear if OSA significantly alters the levels of the soluble isoforms of TNF receptors TNFR1 and TNFR2 and IL6 receptor (IL6R) and co-receptor gp130, which have the potential to modulate TNF and IL6 signaling. Methods Picogram per milliliter levels of the soluble isoforms of these four cytokine receptors were estimated in OSA patients, in OSA patients receiving airways therapy, and in healthy control subjects. Triplicate samples were examined using Bio-Plex fluorescent bead microfluidic technology. The statistical significance of cytokine data was estimated using the nonparametric Wilcoxon rank-sum test. The clustering of these high-dimensional data was visualized using t-distributed stochastic neighbor embedding (t-SNE). Results OSA patients had significant twofold to sevenfold reductions in the soluble serum isoforms of all four cytokine receptors, gp130, IL6R, TNFR1, and TNFR2, as compared with control individuals (p = 1.8 × 10−13 to 4 × 10−8). Relative to untreated OSA patients, airways therapy of OSA patients had significantly higher levels of gp130 (p = 2.8 × 10−13), IL6R (p = 1.1 × 10−9), TNFR1 (p = 2.5 × 10−10), and TNFR2 (p = 5.7 × 10−9), levels indistinguishable from controls (p = 0.29 to 0.95). The data for most airway-treated patients clustered with healthy controls, but the data for a few airway-treated patients clustered with apneic patients. Conclusions Patients with OSA have aberrantly low levels of four soluble cytokine receptors associated with neurodegenerative disease, gp130, IL6R, TNFR1, and TNFR2. Most OSA patients receiving airways therapy have receptor levels indistinguishable from healthy controls, suggesting a chronic intermittent hypoxia may be one of the factors contributing to low receptor levels in untreated OSA patients.

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“…3 Subsequently the AASM Board of Directors established a task force that was charged with recommending standard definitions, criteria and severity ratings for abnormal breathing events during sleep and their associated clinical syndromes. 4 The apnea-hypopnea index (AHI) remains the primary evaluation of OSHAS severity, although AHI has failed to reflect the severity of negative esophageal pressure, 5,6 an important aspect of the pathophysiology of OSAHS, and to assess oxygen desaturation and arousals separately because the apnea-hypopnea definition used results in simultaneous assessment of these two different factors. 4 Events that are characteristic of increased upper airway resistance and do not fulfill the criteria for apnea or hypopnea occur as a result of respiratory efforts during sleep, although they often result in significant symptoms due to arousals.…”

Section: Introductionmentioning

confidence: 99%

Three components of obstructive sleep apnea/hypopnea syndrome

Kumano-go¹,

Mikami²,

Suganuma³

et al. 2003

Psychiatry Clin Neurosci

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The aims of this study were to calculate the apnea-hypopnea index (AHI), which represented as the number of apnea-hypopnea occurrences per hour, the 4% oxygen desaturation index (ODI4) and the breathing-related arousal index (B-ArI) in polysomnographic studies of obstructive sleep apnea/hypopnea syndrome (OSAHS) patients and to investigate whether there was any relationship between each pair of scoring schemes. Thirty-four cases of OSAHS were studied. Total OSAHS patients were subdivided into those with a high AHI ( > 25), and those with a low AHI ( < 25). The correlation between each pair of scoring schemes for OSAHS with a high AHI showed high value. The correlation between AHI and ODI4 for OSAHS with a low AHI was 0.18 and that between AHI and B-ArI showed a weak correlation of 0.59, while that between ODI4 and B-ArI was only -0.078. Our results mean that oxygen desaturation and arousal occur separately in mild or moderate OSAHS patients, even though they are diagnosed with the same level of OSAHS by means of AHI. Breathing-related arousal without oxygen desaturation often occurs in mild or moderate OSAHS patients. We previously reported that AHI does not accurately reflect the severity of the increase in negativity of esophageal pressure manifested as respiratory efforts. We consider that the comprehension and assessment of OSAHS can be improved by the systematic differentiations among the three components: oxygen desaturation, arousals and respiratory efforts.

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Esophageal pressure and apnea hypopnea index in sleep‐disordered breathing

Cited by 8 publications

References 4 publications

Pulse Transit Time for Quantifying Inspiratory Effort in Patients with Obstructive Sleep Apnea

Pulse Transit Time for Quantifying Inspiratory Effort in Patients with Obstructive Sleep Apnea

Patients with obstructive sleep apnea have suppressed levels of soluble cytokine receptors involved in neurodegenerative disease, but normal levels with airways therapy

Three components of obstructive sleep apnea/hypopnea syndrome

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