Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea

Skiba, Virginia; Goldstein, Cathy; Schotland, Helena M.

doi:10.5664/jcsm.4764

Cited by 20 publications

(20 citation statements)

References 19 publications

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“…However, despite these potential limitations, our findings are in accordance and extend previous Poes studies (Chervin & Aldrich, ; Hutter et al, ; Skatvedt et al, ; Skiba et al, ). Additionally, our results are comparable to the only study designed to determine the effects of Poes on PSG measures in OSA (randomised cross‐over trial; Skatvedt et al, ).…”

Section: Discussionsupporting

confidence: 93%

“…Given that the AHI is the main clinical measure of OSA severity, it is pertinent that it is not altered by manometry. Consistent with prior Poes studies (Hutter et al, ; Skatvedt et al, ; Skiba et al, ), Pepi did not systematically change the AHI versus standard PSG. Indeed, the night‐to‐night variability in AHI on the physiology night versus baseline was comparable to repeat standard PSGs in both the current study (PSGN1 and PSGN30) as well as previous studies (Ahmadi, Shapiro, Chung, & Shapiro, ).…”

Section: Discussionsupporting

confidence: 87%

“…Comparable to previous Poes studies (Chervin & Aldrich, ; Hutter et al, ; Skatvedt et al, ; Skiba et al, ), the arousal index also remained unchanged with Pepi in the current study. However, a reduction in sleep quality with Pepi was demonstrated by more light and less deep and REM sleep.…”

Section: Discussionsupporting

confidence: 64%

“…A recent study found that an oesophageal catheter (Poes) does not affect UA collapsibility in anaesthetised people with and without OSA (Maddison et al, 2015). Previous studies indicate small but consistent changes in sleep architecture with various types of Poes catheters (Chervin & Aldrich, 1997;Hutter, Holland, & Ashtyani, 2004;Skatvedt, Akre, & Godtlibsen, 1996;Skiba, Goldstein, & Schotland, 2015). However, Poes catheters tend to be thicker and therefore potentially more disruptive to sleep than thinner epiglottic catheters (Pepi).…”

Section: Introductionmentioning

confidence: 99%

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Polysomnography with an epiglottic pressure catheter does not alter obstructive sleep apnea severity or sleep efficiency

Carter

Carberry

Grunstein

et al. 2018

Journal of Sleep Research

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Pharyngeal and oesophageal manometry is used clinically and in research to quantify respiratory effort, upper‐airway mechanics and the pathophysiological contributors to obstructive sleep apnea. However, the effects of this equipment on respiratory events and sleep in obstructive sleep apnea are unclear. As part of a clinical trial (ANZCTRN12613001106729), data from 28 participants who successfully completed a physiology night with an epiglottic catheter and nasal mask followed by a standard in‐laboratory polysomnography were compared. The apnea–hypopnea index was not different during the physiology night versus standard polysomnography (22 ± 14 versus 23 ± 13 events per hr, p = 0.71). Key sleep parameters were also not different compared between conditions, including sleep efficiency (79 ± 13 versus 81 ± 11%, p = 0.31) and the arousal index (26 ± 11 versus 27 ± 11 arousals per hr, p = 0.83). There were, however, sleep stage distribution changes between nights with less N3 and rapid eye movement sleep and more N1 on the physiology night, with no difference in N2 (53 ± 15 versus 48 ± 9, p = 0.08). However, these changes did not increase next‐day sleepiness. These findings indicate that while minor sleep stage distribution changes do occur towards lighter sleep, epiglottic manometry does not alter obstructive sleep apnea severity or sleep efficiency. Thus, epiglottic manometry can be used clinically and to collect detailed physiological information for research without major sleep disruption.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Polysomnography with an epiglottic pressure catheter does not alter obstructive sleep apnea severity or sleep efficiency

Carter

Carberry

Grunstein

et al. 2018

Journal of Sleep Research

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“…No difference was found between the incWOB and OSA groups of the obstructive SDB spectrum (Berry et al, 2013;Guilleminault, Stoohs, Clerk, Cetel, & Maistros, 1993). In the study by Skiba et al (2015), of 105 adults with a normal PSG [based on apnoea-hypopnoea index (AHI)], 24 (22.9%) patients were diagnosed with SDB in a subsequent sleep study based on pathologically increased respiratory effort (measured by the magnitude of P oes during tidal breathing) despite a normal AHI. The elevated level of sEMGcw during tidal unobstructed breathing in children with OSA compared with the primary snorers in our cohort suggests that sEMGcw was able to detect increased respiratory effort, similar to P oes .…”

Section: Resultsmentioning

confidence: 99%

Quantitative assessment of nocturnal neural respiratory drive in children with and without obstructive sleep apnoea using surface EMG

Chuang

Teng

Butler

et al. 2019

Experimental Physiology

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New Findings What is the central question of this study?Recent studies have suggested potential utility of non‐normalized respiratory muscle EMG as an index of neural respiratory drive (NRD). Whether NRD measured using non‐normalized surface EMG of the lateral chest wall overlying the diaphragm (sEMGcw) recorded during nocturnal clinical polysomnography can differentiate children with and without obstructive sleep apnoea (OSA) is not known. What is the main finding and its importance?Non‐normalized sEMGcw was increased in children with OSA and an additional group of snoring children without OSA but subjectively increased respiratory effort compared with primary snorers. The sEMGcw has potential clinical utility in evaluation of children with sleep‐disordered breathing as an objective, non‐invasive, non‐volitional marker of NRD. Abstract Our aim was to investigate whether neural respiratory drive measured by non‐normalized surface EMG recorded from the chest wall overlying the diaphragm (sEMGcw) differentiates children with and without obstructive sleep apnoea (OSA). Polysomnography data of children aged 0–18 years were divided into the following three groups: (i) primary snorers (PS); (ii) snoring children without OSA but with increased work of breathing (incWOB; subjective physician report of increased respiratory effort during sleep); and (iii) children with OSA [obstructive apnoea–hypopnoea index (OAHI) >1 h−1]. Excerpts of sEMGcw obtained during tidal unobstructed breathing from light, deep and rapid eye movement sleep were exported for quantitative analysis. Overnight polysomnography data from 45 PS [median age 4.4 years (interquartile range 3.0–7.7 years), OAHI 0 h−1 (0.0–0.2 h−1)], 19 children with incWOB [age 2.8 years (2.4–5.7 years), OAHI 0.1 h−1 (0.0–0.4 h−1)] and 27 children with OSA [age 3.6 years (2.6–6.2 years), OAHI 3.7 h−1 (2.3–6.9 h−1)] were analysed. The sEMGcw was higher in those with OSA [8.47 μV (5.98–13.07 μV); P < 0.0001] and incWOB [8.97 μV (5.94–13.43 μV); P < 0.001] compared with PS [4.633 μV (2.98–6.76 μV)]. There was no significant difference in the sEMGcw between children with incWOB and OSA (P = 0.78). Log sEMGcw remained greater in children with OSA and incWOB compared with PS after age, body mass index centiles, sleep stages and sleep positions were included in the mixed linear models (P < 0.0001). The correlation between sEMGcw and OAHI in children without OSA was small (rs = 0.254, P = 0.04). The sEMGcw is increased in children with OSA and incWOB compared with PS.

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Diagnosing narcolepsy in the active duty military population

Villarreal

Brock

et al. 2021

Sleep Breath

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Purpose Narcolepsy type I and type II are central hypersomnias characterized by excessive daytime sleepiness and nocturnal sleep disruptions. These rare disorders make the diagnosis complex, as multiple sleep disorders are known to cause false-positive results on testing. There is a high incidence of sleep disorders in the military, and the diagnosis of narcolepsy can have serious career implications. This study looked to assess for the presence of confounding disorders in patients previously diagnosed with narcolepsy. Methods We conducted a retrospective analysis of patients aged 18-65 previously diagnosed with narcolepsy at an outside facility, referred for repeat evaluation at the Wilford Hall Sleep Disorders Center. Previous test results from the time of original diagnosis were reviewed if available and compared with repeat evaluation which included actigraphy, in-laboratory polysomnography, and multiple sleep latency testing. Results Of the 23 patients, 2 (9%) retained a diagnosis of narcolepsy after repeat testing. Ten patients (43%) had insufficient sleep syndrome, five (22%) had significant circadian rhythm sleep-wake disorders, and nine (39%) patients were diagnosed with mild obstructive sleep apnea (OSA). Four of the nine patients with OSA (44%) had supine predominant OSA. Conclusion Diagnostic testing for narcolepsy may be influenced by the presence of comorbid sleep disorders including sleepdisordered breathing, insufficient sleep duration, and circadian misalignment which are common in active military personnel. This study emphasizes the importance of excluding these comorbid diagnoses in this population.

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Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea

Cited by 20 publications

References 19 publications

Polysomnography with an epiglottic pressure catheter does not alter obstructive sleep apnea severity or sleep efficiency

Polysomnography with an epiglottic pressure catheter does not alter obstructive sleep apnea severity or sleep efficiency

Quantitative assessment of nocturnal neural respiratory drive in children with and without obstructive sleep apnoea using surface EMG

Diagnosing narcolepsy in the active duty military population

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