Fluid Shift by Lower Body Positive Pressure Increases Pharyngeal Resistance in Healthy Subjects

Chiu, Kuo-Liang; Ryan, Clodagh M.; Shiota, Satomi; Ruttanaumpawan, Pimon; Arzt, Michael; Haight, James S. J.; Chan, Christopher T.; Floras, John S.; Bradley, T. Douglas

doi:10.1164/rccm.200607-927oc

Cited by 196 publications

(142 citation statements)

References 40 publications

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“…Furthermore, it is envisaged that fluid accumulation in the upper airway will increase airflow resistance of the pharynx, as reflected by the decrease in minimal pharyngeal cross-sectional area on switching to CAPD. In support of this notion, Chiu et al (18) recently applied lower body positive pressure using antishock trousers to displace fluid from the legs to the upper body, and found that the maneuver resulted in increased pharyngeal airflow resistance. Beecroft et al (19) recently showed that pharyngeal narrowing contributes to the pathogenesis of OSA in dialysis-dependent patients.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Tang¹,

Lam²,

Lai³

et al. 2009

Clinical Journal of the American Society of Nephrology

110

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Background and objectives: Among peritoneal dialysis (PD) patients, nocturnal PD (NPD) is known to improve sleep apnea compared with continuous ambulatory peritoneal dialysis (CAPD), but the contributing factors are unclear.Design, setting, participants, and measurements: Thirty-eight incident ESRD patients underwent overnight polysomnography (PSG) during NPD and CAPD. Bioelectrical impedance analysis, magnetic resonance imaging of the upper airway, and urea kinetics (Kt/V) during sleep were measured on both occasions.Results: The prevalence of severe sleep apnea (apnea-hypopnea index, AHI > 15/h) was 21.1% during NPD, and 42.1% during CAPD. Mean AHI increased from 9.6 ؎ 2.7/h during NPD to 21.5 ؎ 4.2/h during CAPD. Both obstructive and central apnea worsened after conversion to CAPD. NPD achieved greater reductions in total body water, hydration fraction, and net ultrafiltration than CAPD during sleep. Overnight peritoneal Kt/V and creatinine clearance were lower after conversion. Both peritoneal Kt/V and peritoneal creatinine clearance correlated with AHI, as did their changes after conversion. Volumetric magnetic resonance imaging revealed reduced pharyngeal volumes and cross-sectional area, and tongue enlargement after conversion.Conclusions: Improvement in sleep apnea during NPD versus CAPD is associated with better fluid and uremic clearance and reduced upper airway congestion during sleep.

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Section: Discussionmentioning

confidence: 99%

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Tang¹,

Lam²,

Lai³

et al. 2009

Clinical Journal of the American Society of Nephrology

110

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“…This is likely to be caused by fluid shift from the lower limbs into the lung and upper airway resulting in increased airway resistance. 24 There are few studies of patients with acute pulmonary oedema, most likely due to the difficulty involved in studying these patients (Table 1). A study in which 2 L normal …”

Section: Effects Of Hf On Respiratory Function Testingmentioning

confidence: 99%

“…59, 60 In HF patients, the degree of fluid shift from the legs appeared to correlate well with both increasing severity of OSA and CSA. While the change in OSA can be explained by increasing upper airway resistance due to neck oedema, 24 how fluid shifts affect CSA is less clear. The authors postulated that fluid shifts into the lung parenchyma may result in afferent vagal nerve irritation, promoting hyperventilation, which leads to falling CO2 levels and eventual cessation of breathing.…”

Section: Sleep Disordered Breathingmentioning

confidence: 99%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated by its deleterious effects on lung function. HF appears to cause airway obstruction acutely and leads to impaired gas diffusing capacity and pulmonary hypertension in the longer term. It is postulated that this is the result of recurrent episodes of elevated pulmonary capillary pressure leading to pulmonary oedema and pulmonary capillary stress fracture, which produces lung fibrosis. It is likely that impaired lung function impairs the functional status of HF patients and makes them more prone to central sleep apnoea. (Circ J 2010; 74: 2507 - 2516

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“…Previous studies have demonstrated an association between pharyngeal caliber and actively induced acute rostral fluid shift in healthy volunteers (Chiu et al. 2006; White et al. 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Both phenomena have been demonstrated experimentally by actively inducing fluid shift using lower body positive pressure in awake healthy volunteers (Chiu et al. 2006; Shiota et al. 2007; Su et al.…”

Section: Introductionmentioning

confidence: 99%

Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

et al. 2017

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The increased prevalence of obstructive sleep apnea (OSA) in congestive heart failure (CHF) may be associated with rostral fluid shift. We investigated the effect of overnight rostral fluid shift on pharyngeal collapsibility (Pcrit), pharyngeal caliber (APmean), and apnea‐hypopnea index (AHI) in CHF patients. Twenty‐three optimally treated systolic CHF patients were studied. Neck circumference was measured immediately prior to sleep in the evening and immediately after waking in the morning as a marker of rostral fluid shift. Pcrit was measured during sleep, early and late in the night. APmean was measured using acoustic reflection at the same times as neck circumference measurements. 15/23 CHF patients experienced an overnight increase in neck circumference; overall neck circumference significantly increased overnight (mean±SD, evening: 41.7 ± 3.2 cm; morning: 42.3 ± 3.1 cm; P = 0.03). Pcrit increased significantly overnight (early‐night: −3.8 ± 3.3 cmH2O; late‐night: −2.6 ± 3.0 cmH2O; P = 0.03) and APmean decreased (evening: 4.2 ± 1.3 cm2; morning: 3.7 ± 1.3 cm2; P = 0.006). The total AHI correlated with neck circumference (r = 0.4; P = 0.04) and Pcrit (r = 0.5; P = 0.01). APmean correlated with neck circumference (r = −0.47; P = 0.02). There was no significant change in AHI between the first and second half of the night (first‐half: 12.9 ± 12.4/h; second‐half: 13.7 ± 13.3/h; P = 0.6). Overnight rostral fluid shift was associated with increased pharyngeal collapsibility and decreased pharyngeal caliber during sleep in CHF patients. Rostral fluid shift may be an important mechanism of OSA in this patient group.

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Fluid Shift by Lower Body Positive Pressure Increases Pharyngeal Resistance in Healthy Subjects

Cited by 196 publications

References 40 publications

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Improvement in Sleep Apnea during Nocturnal Peritoneal Dialysis Is Associated with Reduced Airway Congestion and Better Uremic Clearance

Heart Failure and the Lung

Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

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