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Published ahead of print on May 28, 2003, doi:10.1164/rccm.200302-201OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 6, September 2003, 645-658

A more recent version of this article appeared on September 15, 2003
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Submitted on February 11, 2003
Accepted on May 28, 2003

CONTRIBUTIONS OF UPPER AIRWAY MECHANICS AND CONTROL MECHANISMS TO SEVERITY OF OBSTRUCTIVE APNEA

Magdy Younes1*

1 Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Internal Medicine, University of Toronto, Toronto, Ontario, Canada

* To whom correspondence should be addressed. E-mail: mkyounes{at}sympatico.ca.

The contributions of pharyngeal mechanical abnormalities, flow demand, and compensatory effectiveness to obstructive sleep apnea severity were determined in 82 patients. Flow demand was estimated from mean inspiratory flow on continuous-positive-airway-pressure. Mechanical load on upper airway muscles was estimated from minimal effective continuous-positive-airway-pressure, flow demand, and minimum flow observed during brief pressure dial-downs. Compensatory effectiveness was estimated by relating polysomnographic severity and mechanical load. Mechanical load was more severe in men, in supine position, and in older and heavier patients. Higher flow demand contributed significantly to mechanical load in men and with obesity. At same mechanical load, severity was independent of age, gender or body-mass-index, but was greater in the supine position and in rapid-eye-movement sleep. Mechanical load accounted for only 34% of variability in severity. 82% of patients experienced periods of stable breathing despite mechanical loads that would produce continuous cycling without compensation. Conclusions: Most patients can adequately compensate for the abnormal mechanics, at least part of the time. Higher flow demand contributes to severity in men and in obesity. Severity is largely due to factors other than mechanical load. Compensatory effectiveness is impaired in supine position and in rapid-eye-movement sleep, but not by age, gender or body-mass-index.
Key words: Age Gender Supine Position Body Mass Index Sleep, REM




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