Flow-volume curve abnormalities and obstructive sleep apnea syndrome.

Recent reports have suggested that flow volume curve abnormalities may be of interest in the diagnosis of obstructive sleep apnea syndromes by showing either extrathoracic airway obstruction (ratio of expiratory flow to inspiratory flow at 50 percent of forced vital capacity [FEF50/FIF50] exceeding 1) or upper airway fluttering (indicated by a sawtooth aspect on the mid-half of the inspiratory part of the curve) or both. In our study, 57 patients referred for a suspected sleep apnea syndrome (SAS) underwent conventional spirometry, assessment of flow-volume curves, ENT examination, and polysomnography. Thirty patients had an obstructive SAS, four patients a central SAS, and 23 patients no SAS. Signs of upper airway fluttering (the sawtooth sign) were present in 61 percent of the patients with obstructive SAS and in 46 percent of the patients without obstructive SAS (central SAS or no SAS). Signs of extrathoracic upper airway obstruction (FEF50/FIF50 greater than 1) were present in 67 percent of the patients with obstructive SAS and in 71 percent of the patients without obstructive SAS. These results suggest that upper airway abnormalities, as reflected by abnormal flow volume curves, are not always associated with obstructive SAS; they favor the hypothesis of a central component in the mechanism of upper airway occlusion during sleep.