help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Published ahead of print on April 7, 2005, doi:10.1164/rccm.200404-552OC
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online Supplement
Right arrow All Versions of this Article:
200404-552OCv1
172/1/114    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Heinzer, R. C.
Right arrow Articles by White, D. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Heinzer, R. C.
Right arrow Articles by White, D. P.
American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 114-117, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200404-552OC

Original Article

Lung Volume and Continuous Positive Airway Pressure Requirements in Obstructive Sleep Apnea

Raphael C. Heinzer, Michael L. Stanchina, Atul Malhotra, Robert B. Fogel, Sanjay R. Patel, Amy S. Jordan, Karen Schory and David P. White

Sleep Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Rhode Island Hospital, Brown Medical School, Providence, Rhode Island

Correspondence and requests for reprints should be addressed to Raphael C. Heinzer, M.D., Division of Sleep Medicine, Sleep Disorders Program @ BI, 75 Francis Street, Boston, MA 02115. E-mail: rheinzer{at}rics.bwh.harvard.edu

Previous studies have demonstrated that lung volume during wakefulness influences upper airway size and resistance, particularly in patients with sleep apnea. We sought to determine the influence of lung volume on the level of continuous positive airway pressure (CPAP) required to prevent flow limitation during non-REM sleep in subjects with sleep apnea. Seventeen subjects (apnea–hypopnea index, 42.6 ± 6.2 [SEM]) were studied during stable non-REM sleep in a rigid head-out shell equipped with a positive/negative pressure attachment for manipulation of extrathoracic pressure. An epiglottic pressure catheter plus a mask/pneumotachometer were used to assess flow limitation. When lung volume was increased by 1,035 ± 22 ml, the CPAP level could be decreased from 11.9 ± 0.7 to 4.8 ± 0.7 cm H2O (p < 0.001) without flow limitation. The decreased CPAP at the same negative extrathoracic pressure yielded a final lung volume increase of 421 ± 36 ml above the initial value. Conversely, when lung volume was reduced by 732 ± 74 ml (n = 8), the CPAP level had to be increased from 11.9 ± 0.7 to 17.1 ± 1.0 cm H2O (p < 0.001) to prevent flow limitation, with a final lung volume decrease of 567 ± 78 ml. These results demonstrate that relatively small changes in lung volume have an important effect on the upper airway in subjects with sleep apnea during non-REM sleep.

Key Words: airflow limitation • continuous positive airway pressure • lung volume • sleep apnea • upper airway




This article has been cited by other articles:


Home page
 ThoraxHome page
A Malhotra and D Hillman
Obesity and the lung: 3 {middle dot} Obesity, respiration and intensive care
Thorax, October 1, 2008; 63(10): 925 - 931.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
J. P. Kirkness, A. R. Schwartz, H. Schneider, N. M. Punjabi, J. J. Maly, A. M. Laffan, B. M. McGinley, T. Magnuson, M. Schweitzer, P. L. Smith, et al.
Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep
J Appl Physiol, June 1, 2008; 104(6): 1618 - 1624.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
D. J. Eckert and A. Malhotra
Pathophysiology of Adult Obstructive Sleep Apnea
Proceedings of the ATS, February 15, 2008; 5(2): 144 - 153.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
A. R. Schwartz, S. P. Patil, A. M. Laffan, V. Polotsky, H. Schneider, and P. L. Smith
Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches
Proceedings of the ATS, February 15, 2008; 5(2): 185 - 192.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
Y. Tagaito, S. Isono, J. E. Remmers, A. Tanaka, and T. Nishino
Lung volume and collapsibility of the passive pharynx in patients with sleep-disordered breathing
J Appl Physiol, October 1, 2007; 103(4): 1379 - 1385.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
A. S Jordan, A. Wellman, R. C Heinzer, Y.-L. Lo, K. Schory, L. Dover, S. Gautam, A. Malhotra, and D. P White
Mechanisms used to restore ventilation after partial upper airway collapse during sleep in humans
Thorax, October 1, 2007; 62(10): 861 - 867.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
R. K. Kakkar and R. B. Berry
Positive Airway Pressure Treatment for Obstructive Sleep Apnea
Chest, September 1, 2007; 132(3): 1057 - 1072.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
S. P. Patil, H. Schneider, A. R. Schwartz, and P. L. Smith
Adult Obstructive Sleep Apnea: Pathophysiology and Diagnosis
Chest, July 1, 2007; 132(1): 325 - 337.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
R. L. Horner
Contributions of passive mechanical loads and active neuromuscular compensation to upper airway collapsibility during sleep
J Appl Physiol, February 1, 2007; 102(2): 510 - 512.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. Eikermann, F. M. Vogt, F. Herbstreit, M. Vahid-Dastgerdi, M. O. Zenge, C. Ochterbeck, A. de Greiff, and J. Peters
The Predisposition to Inspiratory Upper Airway Collapse during Partial Neuromuscular Blockade
Am. J. Respir. Crit. Care Med., January 1, 2007; 175(1): 9 - 15.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
J. P. Kirkness, A. R. Schwartz, S. P. Patil, L. E. Pichard, J. J. Marx, P. L. Smith, and H. Schneider
Dynamic modulation of upper airway function during sleep: a novel single-breath method
J Appl Physiol, November 1, 2006; 101(5): 1489 - 1494.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
A. Oliven and M. Odeh
Effect of positional changes of anatomic structures on upper airway dilating muscle shortening during electro- and chemostimulation
J Appl Physiol, September 1, 2006; 101(3): 745 - 751.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
R C Heinzer, M L Stanchina, A Malhotra, A S Jordan, S R Patel, Y-L Lo, A Wellman, K Schory, L Dover, and D P White
Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea
Thorax, May 1, 2006; 61(5): 435 - 439.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
R. L. Horner and T. D. Bradley
Update in sleep and control of ventilation 2005.
Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 827 - 832.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
E. S. Katz, C. L. Marcus, and D. P. White
Influence of Airway Pressure on Genioglossus Activity during Sleep in Normal Children
Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 902 - 909.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
A. R. Schwartz, J. Kirkness, and P. Smith
Extraluminal tissue pressure: what does it mean?
J Appl Physiol, January 1, 2006; 100(1): 5 - 6.
[Full Text] [PDF]

Home page
 Am. J. Respir. Cell Mol. Bio.Home page
D. P. White
The Pathogenesis of Obstructive Sleep Apnea: Advances in the Past 100 Years
Am. J. Respir. Cell Mol. Biol., January 1, 2006; 34(1): 1 - 6.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
R. C. Heinzer, A. Malhotra, A. S. Jordan, D. A. Wellman, and D. P. White
Effect of CPAP and Lung Volume on Obstructive Sleep Apnea
Am. J. Respir. Crit. Care Med., November 15, 2005; 172(10): 1350 - 1351.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
Y. Sivan and R. Pelayo
Effect of CPAP and Lung Volume on Obstructive Sleep Apnea
Am. J. Respir. Crit. Care Med., November 15, 2005; 172(10): 1349a - 1350.
[Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
S. R. Patel
Shared genetic risk factors for obstructive sleep apnea and obesity
J Appl Physiol, October 1, 2005; 99(4): 1600 - 1606.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2005 American Thoracic Society 		  ATS State of the Art 2009