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Original Research: SLEEP DISORDERS |

Differences in Breathing Patterning During Wakefulness in Patients With Mixed Apnea-Dominant vs Obstructive-Dominant Sleep ApneaMixed-Dominant vs Obstructive-Dominant Sleep Apnea

Motoo Yamauchi, MD, PhD; Shinji Tamaki, MD, PhD; Masanori Yoshikawa, MD, PhD; Yoshinobu Ohnishi, MD, PhD; Hiroshi Nakano, MD, PhD; Frank J. Jacono, MD; Kenneth A. Loparo, PhD; Kingman P. Strohl, MD; Hiroshi Kimura, MD, PhD, FCCP
Author and Funding Information

From the Second Department of Internal Medicine, Department of Respiratory Medicine, (Drs Yamauchi, Tamaki, Yoshikawa, and Kimura), Nara Medical University, Kashihara; the Department of Internal Medicine (Dr Ohnishi), Tenri City Hospital, Tenri; and the Department of Pulmonology (Dr Nakano), Fukuoka National Hospital, Fukuoka, Japan; the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs Jacono and Strohl), Case Western Reserve University and Louis Stokes Cleveland VA Medical Center; and the Department of Electrical Engineering and Computer Science (Dr Loparo), Case Western Reserve University, Cleveland, OH.

Correspondence to: Motoo Yamauchi MD, PhD, Second Department of Internal Medicine, Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan; e-mail: motoo@naramed-u.ac.jp


Funding/Support: This study was supported in part by Grant-in-Aid for Young Scientists (B) [21790781] from The Ministry of Education, Culture, Sports, Science and Technology, Japan; National Institutes of Health, National Heart, Lung, and Blood Institute [Grant R33HL087340-01]; and the Veterans Affairs Research Service.

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


© 2011 American College of Chest Physicians


Chest. 2011;140(1):54-61. doi:10.1378/chest.10-1082
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Background:  Mixed apneas share both central and obstructive components and are often treated as if they are obstructive events. The hypothesis is that patients with obstructive sleep apnea syndrome (OSAS) who exhibit a majority of mixed apneas will differ in ventilatory control from those with predominantly obstructive apneas during wakefulness; moreover, this difference could affect nasal continuous positive airway pressure (CPAP) adherence.

Methods:  In a retrospectively derived case-control study, 5 min of respiratory inductance plethysmography signals during wakefulness prior to sleep onset were extracted from a diagnostic polysomnogram in these groups: (1) mixed apnea-dominant OSAS (mix-OSAS) (n = 36), (2) obstructive apnea-dominant OSAS (pure-OSAS) (n = 20), (3) central apnea-dominant sleep apnea syndrome (pure-CSAS) (n = 6), and (4) control subjects (n = 10). Breathing patterning was compared between the groups using the coefficient of variation (CV) for breath-to-breath inspiration time (Ti), expiration time (Te), Ti + Te (Ttot), and tidal volume, and an information theory-based metric of signal pattern variability (sample entropy). Subsequent CPAP adherence over 12 months was determined in OSAS groups.

Results:  Breath-to-breath CV parameters and sample entropy in the mix-OSAS group were significantly greater as compared with the pure-OSAS and control groups. In a subanalysis, CV and sample entropy were similar in the mix-OSAS and the pure-CSAS groups. CPAP adherence was significantly poorer in mix-OSAS compared with pure-OSAS.

Conclusions:  During wakefulness, both breath patterning and sample entropy in mix-OSAS are similar to pure-CSAS and more variable than in pure-OSAS. In addition, CPAP adherence was decreased in patients with mix-OSAS, which may be related to basic differences in respiratory control.

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