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Am. J. Respir. Crit. Care Med., Volume 162, Number 3, September 2000, 795-800

Assessment of Upper Airway Dynamics in Awake Patients with Sleep Apnea Using Phrenic Nerve Stimulation

FRÉDÉRIC SÉRIÈS, CHRISTIAN STRAUS, ALEXANDRE DEMOULE, VALÉRIE ATTALI, ISABELLE ARNULF, JEAN-PHILIPPE DERENNE, and THOMAS SIMILOWSKI

Centre de recherche de l'Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Québec, Canada; and Laboratoire de Physiopathologie Respiratoire et Service Central d'Explorations Fonctionnelles Respiratoires, Service de Pneumologie, Groupe hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, & UPRES EA 2397, Université Paris VI, France

Phrenic nerve stimulation can reproduce during wakefulness the dissociation between upper airway and inspiratory muscles that is associated with obstructive sleep-related breathing disorders. This could provide a useful management tool in the study of passive upper airway (UA) dynamics during wakefulness in patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS). To assess the feasibility of the technique in this setting, we studied the dynamics of diaphragm twitch-associated inspiratory flow in eight patients with OSAHS. Cervical magnetic stimulation (CMS) and bilateral anterior magnetic phrenic stimulation (BAMPS) were applied at end-expiration during exclusive nasal breathing. Electrical phrenic nerve stimulation (ES) proved not feasible. The driving pressure and the respiratory resistance at peak twitch esophageal pressure obtained at maximal stimulation intensity were significantly higher with BAMPS than with CMS. A twitch-flow limitation pattern was observed in seven of eight subjects; VImax values of flow-limited twitches obtained at 100% stimulation intensity was 0.81 ± 0.5 L/s with BAMPS and 0.87 ± 0.5 L/s with CMS (p = 0.4). The number of flow-limited BAMPS twitches dropped from an average 77.5% to 18.4% with nasal continuous positive airway pressure (CPAP) levels corresponding to the patient's home treatment. We conclude that (1) BAMPS is potentially a useful tool to evaluate the dynamics of flow through the passive UA in awake OSAHS patients, (2) BAMPS may be superior to CMS in evaluating UA properties in OSAHS.




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