Journal
JOURNAL OF APPLIED PHYSIOLOGY
Volume 110, Issue 6, Pages 1627-1637Publisher
AMER PHYSIOLOGICAL SOC
DOI: 10.1152/japplphysiol.00972.2010
Keywords
pathophysiology of sleep apnea; loop gain; pharyngeal closing pressure; upper airway; arousal threshold
Categories
Funding
- National Heart, Lung, and Blood Institute [5R01-HL-048531-16, R01-HL-085188, R01-HL-090897, K24-HL-093218, P01-HL-095491]
- American Heart Association [0840159N, 0575028N]
- NHMRC of Australia [510392]
- Philips
- Apnex Medical
- Cephalon
- Sepracor
- Pfizer
- Merck
- Ethicon
- Medtronic
- SGS
- SHC
- Apnicure
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There is not a clinically available technique for measuring the physiological traits causing obstructive sleep apnea (OSA). Therefore, it is often difficult to determine why an individual has OSA or to what extent the various traits contribute to the development of OSA. In this study, we present a noninvasive method for measuring four important physiological traits causing OSA: 1) pharyngeal anatomy/collapsibility, 2) ventilatory control system gain (loop gain), 3) the ability of the upper airway to dilate/stiffen in response to an increase in ventilatory drive, and 4) arousal threshold. These variables are measured using a single maneuver in which continuous positive airway pressure (CPAP) is dropped from an optimum to various suboptimum pressures for 3- to 5-min intervals during sleep. Each individual's set of traits is entered into a physiological model of OSA that graphically illustrates the relative importance of each trait in that individual. Results from 14 subjects (10 with OSA) are described. Repeatability measurements from separate nights are also presented for four subjects. The measurements and model illustrate the multifactorial nature of OSA pathogenesis and how, in some individuals, small adjustments of one or another trait (which might be achievable with non-CPAP agents) could potentially treat OSA. This technique could conceivably be used clinically to define a patient's physiology and guide therapy based on the traits.
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