Sleep Disorders Research Program, Div. of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Appl Physiol (1985). 2010 Feb;108(2):445-51. doi: 10.1152/japplphysiol.00755.2009. Epub 2009 Nov 25.
Changes in end-expiratory lung volume (EELV) affect upper airway stability. The passive pharyngeal critical pressure (Pcrit), a measure of upper airway collapsibility, is determined using airway pressure drops. The EELV change during these drops has not been quantified and may differ between obese obstructive sleep apnea (OSA) patients and controls. Continuous positive airway pressure (CPAP)-treated OSA patients and controls were instrumented with an epiglottic catheter, magnetometers (to measure change in EELV), and a nasal mask/pneumotachograph. Subjects slept supine in a head-out plastic chamber in which the extrathoracic pressure could be lowered (to raise EELV) while on nasal CPAP. The magnitude of EELV change during Pcrit measurement (sudden reductions of CPAP for 3-5 breaths each minute) was assessed at baseline and with EELV increased approximately 500 ml. Fifteen OSA patients and 7 controls were studied. EELV change during Pcrit measurement was rapid and pressure dependent, but similar in OSA and control subjects (74 +/- 36 and 59 +/- 24 ml/cmH(2)O respectively, P = 0.33). Increased lung volume (mean +521 ml) decreased Pcrit by a similar amount in OSA and control subjects (-3.1 +/- 1.7 vs. -3.9 +/- 1.9 cmH(2)O, P = 0.31). Important lung volume changes occur during passive Pcrit measurement. However, on average, there is no difference in lung volume change for a given CPAP change between obese OSA subjects and controls. Changes in lung volume alter Pcrit substantially. This work supports a role for lung volume in the pathogenesis of OSA, and lung volume changes should be a consideration during assessment of pharyngeal mechanics.
肺末容积(EELV)的变化会影响上气道的稳定性。被动咽腔临界压(Pcrit)是上气道塌陷性的一个衡量指标,通过气道压力下降来确定。但在这些下降过程中,EELV 的变化尚未被量化,而且肥胖阻塞性睡眠呼吸暂停(OSA)患者和对照组之间可能存在差异。对持续气道正压通气(CPAP)治疗的 OSA 患者和对照组进行了会厌导管、磁力计(用于测量 EELV 的变化)和鼻罩/呼吸流量仪的仪器检测。研究对象仰卧在一个头伸出的塑料室内,在该室内可以降低胸外压(增加 EELV),同时给予鼻 CPAP。在 Pcrit 测量过程中(每分钟突然降低 CPAP 3-5 次呼吸)评估 EELV 变化的幅度,基线时和 EELV 增加约 500ml 时分别进行评估。共研究了 15 例 OSA 患者和 7 例对照组。在 OSA 和对照组中,Pcrit 测量过程中的 EELV 变化是快速且依赖压力的,但变化幅度相似(分别为 74 +/- 36 和 59 +/- 24 ml/cmH(2)O,P = 0.33)。增加的肺容量(平均增加 521ml)使 OSA 和对照组的 Pcrit 降低了相似的幅度(-3.1 +/- 1.7 与-3.9 +/- 1.9 cmH(2)O,P = 0.31)。在被动 Pcrit 测量过程中会发生重要的肺容量变化。然而,在给定的 CPAP 变化下,肥胖 OSA 患者和对照组之间的肺容量变化没有差异。肺容量的变化会显著改变 Pcrit。这项工作支持肺容量在 OSA 发病机制中的作用,并且在评估咽腔力学时,肺容量变化应该是一个考虑因素。