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A Simplified Method for Measuring Critical Pressures during Sleep in the Clinical Setting

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Correspondence and requests for reprints should be addressed to Susheel P. Patil, M.D., Johns Hopkins Sleep Disorders Center, Asthma and Allergy Building, 5501 Hopkins Bayview Circle, Room 4B.50, Baltimore, MD 21224. E-mail: spatil{at}jhmi.edu

Upper airway critical pressure measurements correlate with the degree of upper airway obstruction during sleep and may have a role in the diagnosis and treatment of obstructive sleep apnea. Nevertheless, the utility of the critical pressure has not yet been realized in the clinical setting because significant technical expertise is still required for the acquisition and analysis of pressure–flow data. Using segmented regression, we developed and validated a simplified approach to analyze the pressure–flow relationship and to determine the effects of protocol-related factors in 44 subjects with sleep apnea. When compared with expert visual analysis, segmented regression method was found to accurately determine the critical pressure (–0.98 ± 2.47 cm H₂O vs. –1.07 ± 2.47 cm H₂O, respectively; p = 0.46). Furthermore, it was found that two series of measurements acquired at varying nasal pressure levels with two or more breaths per level were sufficient to determine the critical pressure with a minimum of variability. Therefore, this analytic approach has the potential for standardizing and simplifying the ascertainment of the critical pressure for studies examining the effect of therapeutic devices and agents on upper airway collapsibility during sleep.

Key Words: sleep apnea • critical pressure • pathophysiology • upper airway

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