Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium.
Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
Respir Res. 2023 May 31;24(1):143. doi: 10.1186/s12931-023-02452-z.
Continuous positive airway pressure (CPAP) is the mainstay of treatment for obstructive sleep apnea (OSA). However, data about its effect on the upper airway, especially the epiglottis, are scarce. The aim of this study was to investigate the changes in upper airway dimensions and inspiratory flow in response to incremental pressure levels.
This is a secondary analysis of a prospective clinical trial in which patients with moderate to severe OSA underwent drug-induced sleep endoscopy with simultaneous recordings of flow and mask pressure. CPAP was titrated in small increments. For each pressure level a representative 3-breath segment was selected to determine specific flow features. The corresponding endoscopic footage was reviewed to assess the degree of upper airway collapse in a semi-quantitative manner.
A total of 214 breath segments were obtained from 13 participants (median [Q1-Q3]; apnea-hypopnea index, 24.9 [20.1-43.9] events/h; body mass index 28.1 [25.1-31.7] kg/m²). CPAP significantly increased cross-sectional dimensions of the soft palate, lateral walls and tongue base, but not of the epiglottis, and induced epiglottis collapse in one subject. Increased pressure improved peak inspiratory flow and median ventilation in all patients, even in the presence of persistent epiglottis collapse.
CPAP does not effectively address epiglottis collapse in patients with OSA. However, it normalizes inspiratory flow regardless of its effect on the epiglottis. This clinical trial was registered on January 18th, 2020 on ClinicalTrials.gov with identifier NCT04232410.
持续气道正压通气（CPAP）是治疗阻塞性睡眠呼吸暂停（OSA）的主要方法。然而，关于其对上气道，特别是会厌的影响的数据却很少。本研究旨在研究上气道尺寸和吸气流量随递增压力水平的变化。
这是一项前瞻性临床试验的二次分析，其中中重度 OSA 患者接受药物诱导睡眠内镜检查，同时记录流量和面罩压力。CPAP 以小增量滴定。对于每个压力水平，选择一个有代表性的 3 次呼吸段来确定特定的流量特征。审查相应的内镜录像，以半定量方式评估上气道塌陷的程度。
从 13 名参与者中获得了总共 214 个呼吸段（中位数[Q1-Q3]；呼吸暂停低通气指数 24.9 [20.1-43.9] 次/小时；体重指数 28.1 [25.1-31.7] kg/m²）。CPAP 显著增加了软腭、侧壁和舌根的横截面积，但不会增加会厌的横截面积，并且在一名患者中引起会厌塌陷。在所有患者中，增加压力都会改善吸气峰流量和中位通气量，即使存在持续的会厌塌陷也是如此。
CPAP 不能有效解决 OSA 患者的会厌塌陷问题。然而，它可以使吸气流量正常化，而不论其对会厌的影响如何。该临床试验于 2020 年 1 月 18 日在 ClinicalTrials.gov 上注册，标识符为 NCT04232410。
