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Clinical Investigations: SLEEP AND BREATHING |

Treatment Effects on Carbon Dioxide Retention in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome*

Fang Han, MD; Erzhang Chen, MD; Hailing Wei, BS; Quanying He, MD; Dongjie Ding, MD; Kingman P. Strohl, MD, FCCP
Author and Funding Information

*From the Department of Medicine (Drs. Han and Strohl), Louis Stokes VA Medical Center, Case Western Reserve University, Cleveland, OH; and the Department of Medicine (Drs. Chen, He, and Ding, and Ms. Wei), People’s Hospital, Medical School of Beijing University, Beijing, China.

Correspondence to: Kingman P. Strohl, MD, FCCP, VAMC 111j(w), 10701 East Blvd, Cleveland OH 44106; e-mail: KPSTROHL@aol.com



Chest. 2001;119(6):1814-1819. doi:10.1378/chest.119.6.1814
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Objectives: This study was designed to examine respiratory control in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), with or without CO2 retention.

Methods: We recruited 10 body mass index-matched, apnea-hypopnea index-matched, age-matched, and lung function-matched OSAHS patients, according to their awake Paco2. Five patients were hypercapnic (Paco2, ≥ 45 mm Hg), and five patients were eucapnic. Hypoxic responses (the ratio of the change in minute ventilation [ΔV̇e] to the change in arterial oxygen saturation[Δ Sao2] and the ratio of the change in mouth occlusion pressure over the first 100 ms of inspiration against an occluded airway [ΔP0.1] toΔ Sao2) and hypercapnic responses (ΔV̇e/ΔPco2 ratio andΔ P0.1/ΔPco2 ratio) were tested during wakefulness before treatment in all 10 patients, and before and during treatment (at 2, 4, and 6 weeks) with pressure support in the hypercapnic group.

Results: Hypercapnic patients had lower mean (± SD)Δ V̇e/ΔSao2 ratio than eucapnic patients (−0.17 ± 0.04 vs −0.34 ± 0.04 L /min/%Sao2, respectively), lower meanΔ P0.1/ΔSao2 ratio (−0.04 ± 0.02 vs −0.14 ± 0.03 cm H2O/%Sao2, respectively), and lower ΔP0.1/ΔPco2 ratio (0.23 ± 0.1 vs 0.49 ± 0.1 cm H2O/mm Hg, respectively)[ p < 0.05]. After receiving noninvasive ventilation treatment, the hypercapnic and hypoxic responses of the hypercapnic patients increased. At 4 to 6 weeks, values for both responses had increased to within the normal range and Paco2 had fallen to< 45 mm Hg, while weight was unchanged.

Conclusions: Depressed chemoresponsiveness plays a role that is independent of obesity in the development of CO2 retention in some OSAHS patients, and it may be a response to sleep-disordered breathing.

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