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Original Research: SLEEP MEDICINE |

Relationship Between Critical Pressure and Volume Exhaled During Negative Pressure in Awake Subjects With Sleep-Disordered Breathing

Luigi Taranto Montemurro, MD; Michela Bettinzoli, MD; Luciano Corda, MD; Alessia Braghini, MD; Claudio Tantucci, MD
Author and Funding Information

From the Cattedra di Malattie dell’Apparato Respiratorio (Drs Taranto Montemurro, Bettinzoli, Braghini, and Tantucci), Università degli Studi di Brescia; and Prima Divisione di Medicina Interna (Dr Corda), Spedali Civili, Brescia, Italy.

Correspondence to: Luciano Corda, MD, Prima Divisione di Medicina, Spedali Civili, P.le Spedali Civili n° 1, 25123 Brescia, Italy; e-mail: luciano.corda@spedalicivili.brescia.it


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1304-1309. doi:10.1378/chest.09-2109
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Background:  Critical pressure (Pcrit) is considered a reliable parameter to evaluate the mechanical properties of the passive upper airway (UA) and is significantly increased in patients with obstructive sleep apnea-hypopnea (OSAH) compared with normal subjects. The volume exhaled in the first 0.5 s after application at the mouth of 5 cm H2O negative pressure at the onset of expiration (V,NEP0.5) during wakefulness has been used as a marker of UA collapsibility. The aim of this study was to investigate if there is a significant relationship between V,NEP0.5 and Pcrit in normal subjects, snorers, and patients with OSAH.

Methods:  Thirty men, 10 with OSAH (aged 64 ± 9.1 years, BMI 32 ± 4.9 kg/m2, apnea-hypopnea index [AHI] 43.8 ± 24, neck circumference 46.6 ± 3.7 cm), 10 snorers (aged 68 ± 11 years, BMI 26.6 ± 4.6 kg/m2, AHI 3.5 ± 0.8, snoring time ≥ 30% of sleep time, neck circumference 42.2 ± 3.9 cm), and 10 controls (aged 67 ± 12 years, BMI 25.4 ± 2.2 kg/m2, AHI 1.9 ± 1.2, neck circumference 41.2 ± 2.2 cm) underwent V,NEP0.5 measurement in supine position while awake and Pcrit measurement during sleep. Correlation between V,NEP0.5 and Pcrit was performed in all subjects.

Results:  Controls had V,NEP0.5 of 456 ± 82 mL and Pcrit of −1.38 ± 0.6 cm H2O, snorers had V,NEP0.5 of 321 ± 33 mL and Pcrit −0.55 ± 0.3 cm H2O, and patients with OSAH showed V,NEP0.5 of 295 ± 67 mL and Pcrit of 0.99 ± 1 cm H2O (P < .001 vs normal subjects). A strong correlation was found between V,NEP0.5 and Pcrit (r2 = 0.61, P < .0001).

Conclusions:  In males with neck circumference > 37 cm, V,NEP0.5 during wakefulness strongly reflects Pcrit in a wide range of values. Our findings suggest that V,NEP0.5 can be used as valuable substitute for Pcrit to assess UA collapsibility for clinical and research purposes in these subjects.

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