期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 190, 期 8, 页码 930-937出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.201404-0783OC
关键词
apnea phenotypes; upper airway muscles; obesity; control of breathing; mathematical model
资金
- National Institutes of Health [5R01HL048531-16, R01HL102321, 1R01HL090897-01A2, 1K24HL093218-01A1, 1P01HL095491]
- American Heart Association Postdoctoral Fellowship [11POST7360012]
- National Health and Medical Research Council of Australia (NHMRC) Early Career Fellowship [1053201]
- R. G. Menzies award
- NHMRC R. D. Wright Fellowship [1049814]
- Australian Research Council Future Fellowship [100100203]
- NHMRC C. J. Martin Overseas Biomedical Fellowship [1035115]
Rationale: Body habitus is a major determinant of obstructive sleep apnea (OSA). However, many individuals do not have OSA despite being overweight/obese (body mass index > 25 kg/m(2)) for reasons that are not fully elucidated. Objectives: To determine the key physiologic traits (upper-airway anatomy/collapsibility, upper-airway muscle responsiveness, chemoreflex control of ventilation, arousability from sleep) responsible for the absence of OSA in overweight/obese individuals. Methods: We compared key physiologic traits in 18 overweight/ obese subjects without apnea (apnea-hypopnea index < 15 events per hour) with 25 overweight/obese matched patients with OSA (apnea hypopnea index >= 15 events per hour) and 11 normal-weight nonapneic control subjects. Traits were measured by repeatedly lowering continuous positive airway pressure to subtherapeutic levels for 3 minutes during non-REM sleep. Measurements and Main Results: Overweight/obese subjects without apnea exhibited a less collapsible airway than overweight/ obese patients with apnea (critical closing pressure: -3.7 +/- 1.9 vs. 0.6 +/- 1.2 cm H2O; P = 0.003; mean +/- 95% confidence interval), but a more collapsible airway relative to normal-weight control subjects (-8.8 +/- 3.1 cm H2O; P < 0.001). Notably, overweight/obese subjects without apnea exhibited a threefold greater upper-airway muscle responsiveness than both overweight/obese patients with apnea (Delta genioglossus EMG/Delta epiglottic pressure: -0.49 [-0.22 to -0.79] vs. -0.15 [-0.09 to -0.22] %max/cm H2O; P = 0.008; mean [95% confidence interval]) and normal-weight control subjects (-0.16 [-0.04 to -0.30] %max/cm H2O; P = 0.02). Loop gain was elevated (more negative) in both overweight/obese groups and normal-weight control subjects (P = 0.02). Model-based analysis demonstrated that overweight/obese individuals without apnea rely on both more favorable anatomy and collapsibility and enhanced upper-airway dilator muscle responses to avoid OSA. Conclusions: Overweight/obese individuals without apnea have a moderately compromised upper-airway structure that is mitigated by highly responsive upper-airway dilator muscles to avoid OSA. Elucidating the mechanisms underlying enhanced muscle responses M this population may provide clues for novel OSA interventions.
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