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Hypercapnia and Ventilatory Periodicity in Obstructive Sleep Apnea Syndrome

Division of Pulmonary and Critical Care Medicine and Bellevue Hospital Chest Service, Department of Medicine, New York University School of Medicine, New York, New York

Correspondence and requests for reprints should be addressed to Indu Ayappa, Ph.D., New York University School of Medicine, 550 First Avenue, NBV7W54 New York, NY 10016. E-mail: indu.ayappa{at}med.nyu.edu

ABSTRACT

Prevention of acute hypercapnia during obstructive events in obstructive sleep apnea requires a balance between carbon dioxide (CO₂) loading during the event and CO₂ unloading in the interevent period. Earlier studies have demonstrated that acute CO₂ retention may occur despite high interevent ventilation when the interevent duration is short relative to the duration of the preceding event. The present study examines the relationship between apnea and interapnea durations and relates this assessment of ventilatory periodicity to the degree of chronic hypercapnia in subjects with severe sleep apnea. A total of 18 subjects with sleep apnea (> 40 apnea/hour; chronic awake Pa_CO2 36–62 mm Hg) and without underlying lung disease underwent polysomnography. For each event, apnea duration, interapnea duration, and apnea/interapnea duration ratio were determined. No relationship was observed between chronic Pa_CO2 and mean apnea or interapnea duration (p > 0.1). However, Pa_CO2 was directly related to apnea/interapnea duration ratio (r = 0.48; p < 0.05) such that with increasing chronic hypercapnia the interapnea duration shortens relative to the apnea duration. The present study suggests that control of the interapnea ventilatory duration relative to the duration of the preceding apnea, is an important component of the integrated ventilatory response to CO₂ loading during apnea and may contribute toward the development and/or maintenance of chronic hypercapnia in obstructive sleep apnea/hypopnea syndrome.

Key Words: carbon dioxide • hypercapnia (physiopathology) • sleep apnea, obstructive (physiopathology) • Pickwickian syndrome • obesity

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