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Respiratory Effort During Obstructive Sleep Apnea : Role of Age and Sleep State FREE TO VIEW

Jean Krieger; Emilia Sforza; An Boudewijns; Monica Zamagni; Christophe Petiau
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From the Sleep Disorders Unit, University Hospital, Strasbourg, France

1997 by the American College of Chest Physicians

Chest. 1997;112(4):875-884. doi:10.1378/chest.112.4.875
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Objective: To evaluate the patients' individual characteristics predictive of the degree of respiratory effort developed during obstructive sleep apneas (OSAs).

Design: Prospective consecutive sample, collection of clinical and polysomnographic data.

Setting: University teaching hospital.

Patients: One hundred sixteen consecutive OSA patients with clinical symptoms of OSA and more than 20 apneas per hour of sleep.

Measurements: Anthropomorphic data, daytime blood gas values, and polysomnographic data. From esophageal pressure measurements during sleep, three indexes of respiratory effort during OSAs were derived: the maximal end-apneic esophageal pressure swing (PesMax), the increase in esophageal pressure swing (ΔPes) during the apnea, and its ratio to apnea duration (RPes).

Results: The indexes of respiratory effort were significantly lower in rapid eye movement (REM) than in non-REM sleep (PesMax: 50.9±2.5 vs 39.6±1.9 cm H2O, p<0.001; ΔPes: 30.9±1.7 vs 23.4±1.4 cm H2O, p<0.001; RPes: 1.05±0.05 vs 0.53±0.03 cm H2O/s, p<0.001); therefore, a separate analysis was conducted in non-REM and in REM sleep. Indexes were also significantly lower in subgroups of older as compared to younger patients (PesMax: 55.6±3.5 vs 40.0±2.2 cm H2O, p<0.001; ΔPes: 34.2±2.3 vs 24.1±1.6 cm H2O, p=0.001; RPes: 1.21±0.08 vs 0.8±0.05 cm H2O/s, p<0.001). The three indexes were closely correlated with each other and only PesMax correlation data are reported. In non-REM sleep, age was the most important single independent correlate of PesMax (r=−0.37, p=0.000). In REM sleep, the apnea-related hypoxemia, apnea duration, and age were the main contributors to the variance of PesMax.

Conclusions: Respiratory effort in response to upper airway occlusion in OSA patients is lower in REM than in non-REM sleep and decreases with increasing age.




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