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

Abstract

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.

Objective Pharyngeal Phenotyping in Obstructive Sleep Apnea With High‐Resolution Manometry

“…25,26 We suspect HRM studies during natural sleep may be possible, as other natural sleep studies did not demonstrate significant changes in upper airway collapsibility or polysomnographic variables with manometry catheters of similar diameter. 34,35 A prior report of esophageal manometry during polysomnography noted that placement of a 6-French catheter was tolerated by all patients in which it was attempted, with no clinically significant effects on sleep architecture. 36 Multiple machine learning models were evaluated for accuracy and F1-scores including KNN, support vector machines, logistic regression, random forest, and Naive Bayes.…”

“…Lastly, our system was constructed from solid‐state sensors on a 6‐French catheter, which is smaller than manometry catheters used previously in natural sleep for surgical planning 25,26 . We suspect HRM studies during natural sleep may be possible, as other natural sleep studies did not demonstrate significant changes in upper airway collapsibility or polysomnographic variables with manometry catheters of similar diameter 34,35 . A prior report of esophageal manometry during polysomnography noted that placement of a 6‐French catheter was tolerated by all patients in which it was attempted, with no clinically significant effects on sleep architecture 36 …”

The Application of Ultrasound to Quantify Hyoid Motion During Drug‐Induced Sleep Endoscopy

“…CPAP (S9 VPAP, ResMed Inc., San Diego, CA) was applied and titrated using a nasal or customized oro‐nasal mask (Pulmodyne, Indianapolis, IN) attached to a pneumotachometer. A pressure‐sensitive catheter (Mikro‐cath™, Millar, Houston, TX) was passed to the retro‐epiglottic space to measure respiratory effort (Millar, Houston, TX) 21 . Pulse oximetry was monitored, and a dual‐lumen oral cannula provided supplemental O 2 (2–4 L/min) and measured end‐tidal CO 2 to detect mouth breathing.…”

“…A pressuresensitive catheter (Mikro-cath™, Millar, Houston, TX) was passed to the retro-epiglottic space to measure respiratory effort (Millar, Houston, TX). 21 Pulse oximetry was monitored, and a dual-lumen oral cannula provided supplemental O 2 (2-4 L/min) and measured end-tidal CO 2 to detect mouth breathing. Propofol anesthesia was administered to achieve sedation using a probability ramp infusion system as previously described, with a target Bispectral Index (BIS) (Medtronic, Minneapolis, Minnesota) range of 50-70.…”

Airway Collapsibility during Drug‐Induced Sleep Endoscopy Relates with Clinical Features of Obstructive Sleep Apnea

“…The nasolaryngoscope was passed through a custom‐fitted mask into the nasal cavity. A pressure‐sensitive catheter (Mikro‐cath™, Millar, Houston, TX) was passed intranasally to the retro‐epiglottic space to measure respiratory effort 37 . CPAP (S9 VPAP, ResMed Inc., San Diego CA) was applied and titrated using a modified nasal mask (Pulmodyne, Indianapolis, IN) attached to a pneumotachometer for airflow monitoring.…”