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Published ahead of print on April 7, 2005, doi:10.1164/rccm.200404-552OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 1, July 2005, 114-117

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Submitted on April 27, 2004
Accepted on April 4, 2005

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

Raphael C Heinzer1*, Michael L Stanchina2, Atul Malhotra1, Robert B Fogel1, Sanjay R Patel1, Amy S Jordan1, Karen Schory1, and David P White1

1 Sleep Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 2 Rhode Island Hospital, Brown Medical School, Providence, RI, USA

* To whom correspondence should be addressed. 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 sleep apnea patients. 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 rapid eye movement (NREM) sleep in sleep apnea subjects. Seventeen subjects [Apnea Hypopnea Index 42.6±6.2(SEM)] were studied during stable NREM 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 1035±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 cmH2O(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 sleep apnea subjects during NREM sleep.
Key words: Upper airway, Lung Volume, CPAP, Airflow Limitation, Sleep Apnea




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