Am. J. Respir. Crit. Care Med., Volume 157, Number 5, May 1998, 1522-1525

Surface Tension Forces in Sleep Apnea: The Role of a Soft Tissue Lubricant
A Randomized Double-blind, Placebo-controlled Trial

RUZICA JOKIC, ARTUR KLIMASZEWSKI, JOSEPH MINK, and MICHAEL F. FITZPATRICK

Division of Respiratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Upper airway obstruction in patients with sleep apnea may occur in the absence of a negative intraluminal upper airway pressure. We hypothesized that surface tension forces may play a role in the pathogenesis of obstructive sleep apnea (OSA), and that a topical soft tissue lubricant might reduce the severity of OSA. Ten male patients (age 49 ± 10 yr [mean ± SD]; body mass index [BMI] 31 ± 5 kg/m²) with OSA (apnea-hypopnea index [AHI] 17 ± 9) were studied. The arousal index was lower with the lubricant treatment than with placebo (mean difference 8; 95% CI 4 to 11 arousals/h; p = 0.001). The AHI was lower, in each of the 10 patients, on the lubricant treatment than the placebo (mean change 10, 95% CI 6 to 13; p = 0.0003). The lower AHI with lubricant as compared with placebo was present in both supine (mean difference 13; 95% CI 5 to 20; p = 0.006) and nonsupine (mean difference 6; 95% CI 0 to 12; p = 0.05) positions. There was no significant difference in sleep architecture between the lubricant and placebo treatments. Application of a topical lubricant consistently reduced the severity of OSA. This implies a pathogenetic role for surface tension forces in OSA, and a potential role for surface tension-reducing agents in the treatment of OSA.

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