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Original Research: SLEEP MEDICINE |

Distinguishing Obstructive From Central Sleep Apnea Events: Diaphragm Electromyogram and Esophageal Pressure Compared

Yuan-Ming Luo, PhD; Jing Tang, MB; Caroline Jolley, MD; Joerg Steier, MD; Nan-Shan Zhong, MD, FCCP; John Moxham, MD; Michael Iain Polkey, PhD
Author and Funding Information

*From the Guangzhou Medical College (Drs. Luo, Tang, and Zhong), State Key Laboratory of Respiratory Disease, Guangzhou, People's Republic of China; King's College Hospital (Drs. Jolley, Steier, and Moxham), London, UK; and Royal Brompton Hospital (Dr. Polkey), London, UK.

Correspondence to: Yuan-Ming Luo, PhD, State Key Laboratory of Respiratory Disease, 151 Yanjiang Rd, Guangzhou 510120, People's Republic of China; e-mail: yuanmingluo9431@yahoo.co.uk


All work for this study was performed at State Key Laboratory of Respiratory Disease of China and was supported by the following grants: Chinese Natural Scientific Foundation; and the Guangdong Natural Scientific Foundation.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1133-1141. doi:10.1378/chest.08-1695
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Background:  Distinguishing central sleep apnea (CSA) from obstructive sleep apnea (OSA) can be clinically important because different types of apnea may require different treatment approaches. Academically, this distinction is important for investigating the pathological mechanism of different types of sleep apnea. Conventional polysomnography (PSG) with recording of chest and abdominal movement may overestimate the frequency of CSA, leading to inappropriate treatment of sleep-disordered breathing. We hypothesized that diaphragm electromyogram (EMGdi) could be a useful technique to assess neural respiratory drive and respiratory effort and, therefore, to distinguish accurately CSA from OSA.

Methods:  A multipair esophageal electrode catheter mounted with a balloon was used to record the EMGdi and esophageal pressure (Pes) during overnight PSG. Nineteen patients were included in the study, 12 of whom had previously been identified as having central apnea-hypopnea on a diagnostic PSG undertaken for symptoms that suggest OSA and 7 of whom were known to have heart failure.

Results:  A good relationship was found between the swing of Pes and the root mean (± SD) square of the EMGdi during OSA events (0.89 ± 0.10). About one third of CSA events diagnosed by uncalibrated respiratory inductance plethysmography could not be confirmed by Pes or EMGdi. No difference was found in the number of CSAs diagnosed by Pes (1,319) vs EMGdi (1,293; p > 0.01).

Conclusions:  We conclude that both Pes and EMGdi measurements are useful in accurately differentiating central from obstructive respiratory events. Conventional PSG with recording of chest and abdominal movement overestimates the frequency of CSA events.

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