Effects of respiratory drive on upper airways in sleep apnea patients and normal subjects.
We compared the changes in nasal and pharyngeal resistance induced by modifications in the central respiratory drive in 8 patients with sleep apnea syndrome (SAS) with the results of 10 normal men. Upper airway pressures were measured with two low-bias flow catheters; one was placed at the tip of the epiglottis and the other above the uvula. Nasal and pharyngeal resistances were calculated at isoflow. During CO2 rebreathing and during the 2 min after maximal voluntary hyperventilation, we continuously recorded upper airway pressures, airflow, end-tidal CO2, and the mean inspiratory flow (VT/TI); inspiratory pressure generated at 0.1 s after the onset of inspiration (P0.1) was measured every 15-20 s. In both groups upper airway resistance decreased as P0.1 increased during CO2 rebreathing. When P0.1 increased by 500%, pharyngeal resistance decreased to 17.8 +/- 3.1% of base-line values in SAS patients and to 34.9 +/- 3.4% in normal subjects (mean +/- SE). During the posthyperventilation period the VT/TI fell below the base-line level in seven SAS patients and in seven normal subjects. The decrease in VT/TI was accompanied by an increase in upper airway resistance. When the VT/TI decreased by 30% of its base-line level, pharyngeal resistance increased to 319.1 +/- 50.9% in SAS and 138.5 +/- 4.7% in normal subjects (P less than 0.05). We conclude that 1) in SAS patients, as in normal subjects, the activation of upper airway dilators is reflected by indexes that quantify the central inspiratory drive and 2) the pharyngeal patency is more sensitive to the decrease of the central respiratory drive in SAS patients than in normal subjects.
Sériès
F
F
Centre de Pneumologie, Hôpital Laval, Sainte-Foy, Quebec, Canada.
Cormier
Y
Y
Desmeules
M
M
La Forge
J
J
D000328:Adult; D000403:Airway Resistance; D002245:Carbon Dioxide; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009666:Nose; D010614:Pharynx; D012119:Respiration; D012132:Respiratory Muscles / Q000503:physiopathology; D012891:Sleep Apnea Syndromes / Q000503:physiopathology*
D002245:Carbon Dioxide