Raquel Pastrello Hirata1, Fabiane Kayamori1, Fabiola Schorr1, Henrique Takachi Moriya2, Salvatore Romano3, Giuseppe Insalaco3, Eloisa Gebrim4, Luis Vicente Franco de Oliveira5, Pedro Rodrigues Genta1, Geraldo Lorenzi-Filho6. 1. Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Doutor Eneas de Carvalho Aguiar, 44, 8° Andar, Bloco I, CEP, São Paulo, SP, 05403-900, Brazil. 2. Biomedical Engineering Laboratory, Escola Politécnica, Universidade de São Paulo, São Paulo, Brazil. 3. Italian National Research Council, Institute of Biomedicine and Molecular Immunology A. Monroy, Palermo, Italy. 4. Radiology Institute (InRad), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 5. Rehabilitation Sciences Master and Doctoral Program, Universidade Nove de Julho, São Paulo, Brazil. 6. Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Doutor Eneas de Carvalho Aguiar, 44, 8° Andar, Bloco I, CEP, São Paulo, SP, 05403-900, Brazil. geraldo.lorenzi@gmail.com.
Abstract
PURPOSE: Negative expiratory pressure (NEP) is a simple technique for the evaluation of upper airway collapsibility in patients with obstructive sleep apnea (OSA). Most studies evaluated NEP using a mouthpiece that may exclude the cephalic portion of the upper airway. We hypothesize that NEP determination is influenced by interface and position. METHODS: We evaluated patients with suspected OSA using polysomnography, NEP (-5 cmH2O in sitting and supine position with mouthpiece and nasal mask). A subgroup also underwent computed tomography (CT) of the upper airway. RESULTS: We studied a total of 86 subjects (72 male, age 46 ± 12 yrs, body mass index 30.0 ± 4.4 kg/m2, neck circumference 40.0 ± 3.5 cm, AHI 32.9 ± 26.4, range 0.5 to 122.5 events/hour). NEP was influenced by interface and position (p = 0.007), and upper airway was more collapsible with mouthpiece than with nasal mask in sitting position (p = 0.001). Position influenced NEP and was worse in supine only when evaluated by nasal mask. Expiratory resistance (R 0.2) at 0.2 s during NEP was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 versus 8.6 cmH2O/L s-1, respectively, p = 0.018). NEP evaluated with nasal mask in supine position and with mouthpiece in sitting position, but not when evaluated with mouthpiece in supine position, were correlated with upper airway anatomical measurements including tongue dimensions and pharyngeal length. CONCLUSIONS: Interface and position influence NEP. NEP evaluated with nasal mask in supine position may convey more relevant information for patients under investigation for OSA than when evaluated with mouthpiece.
PURPOSE: Negative expiratory pressure (NEP) is a simple technique for the evaluation of upper airway collapsibility in patients with obstructive sleep apnea (OSA). Most studies evaluated NEP using a mouthpiece that may exclude the cephalic portion of the upper airway. We hypothesize that NEP determination is influenced by interface and position. METHODS: We evaluated patients with suspected OSA using polysomnography, NEP (-5 cmH2O in sitting and supine position with mouthpiece and nasal mask). A subgroup also underwent computed tomography (CT) of the upper airway. RESULTS: We studied a total of 86 subjects (72 male, age 46 ± 12 yrs, body mass index 30.0 ± 4.4 kg/m2, neck circumference 40.0 ± 3.5 cm, AHI 32.9 ± 26.4, range 0.5 to 122.5 events/hour). NEP was influenced by interface and position (p = 0.007), and upper airway was more collapsible with mouthpiece than with nasal mask in sitting position (p = 0.001). Position influenced NEP and was worse in supine only when evaluated by nasal mask. Expiratory resistance (R 0.2) at 0.2 s during NEP was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 versus 8.6 cmH2O/L s-1, respectively, p = 0.018). NEP evaluated with nasal mask in supine position and with mouthpiece in sitting position, but not when evaluated with mouthpiece in supine position, were correlated with upper airway anatomical measurements including tongue dimensions and pharyngeal length. CONCLUSIONS: Interface and position influence NEP. NEP evaluated with nasal mask in supine position may convey more relevant information for patients under investigation for OSA than when evaluated with mouthpiece.
Entities:
Keywords:
Anatomy; Obstructive sleep apnea; Pathophysiology; Pharynx; Supine position
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