title: High-flow transtracheal insufflation treats obstructive sleep apnea. A pilot study.
abstract: To determine the effect of transtracheal insufflation (TTI) on obstructive sleep apnea (OSA), we examined breathing patterns in five tracheostomized patients with OSA at varying TTI flow rates when breathing with a closed tracheostomy. The breathing patterns and polysomnographic responses to air insufflation were studied as TTI was increased from 0 to 15 L/min for brief periods of non-rapid eye movement (NREM) sleep (Experiment 1). The frequency of sleep-disordered breathing episodes remained high at 0 and 5 L/min (87.0 +/- 33.7 and 79.4 +/- 24.4 episodes per hour NREM) and decreased significantly to 41.3 +/- 31.5 and 43.4 +/- 31.4 episodes/h NREM sleep at rates of 10 and 15 L/min, respectively (p = 0.003). At high levels of TTI (10 and 15 L/min), obstructive apneas and hypopneas decreased but periodic laryngeal obstructions were induced during stage 1 NREM sleep. To prevent laryngeal obstructions, a servo-control system was used to briefly interrupt TTI during these events. When this system was implemented for more prolonged periods of sleep (Experiment 2, total sleep time 176.6 +/- 12.5 min), high-flow TTI (hf-TTI, 15 L/min) led to an overall reduction in the combined frequency of obstructive apneas and laryngeal obstructions from 63.8 +/- 21.8 to 10.7 +/- 9.1 (p < 0.03) and was associated with a marked reduction in arousal frequency from 60.0 +/- 26.0 to 8. 3 +/- 5.4/h in NREM sleep, and from 67.5 +/- 3.5 to 0 +/- 0/h in rapid eye movement (REM) sleep. Our findings demonstrate that hf-TTI stabilized breathing patterns in apneic patients, and was safe and efficacious for prolonged periods of sleep.
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, and Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: H
authors.initials: H
authors.lastname: Schneider
authors.forename: D J
authors.initials: DJ
authors.lastname: O'Hearn
authors.forename: K
authors.initials: K
authors.lastname: Leblanc
authors.forename: P L
authors.initials: PL
authors.lastname: Smith
authors.forename: C P
authors.initials: CP
authors.lastname: O'Donnell
authors.forename: D W
authors.initials: DW
authors.lastname: Eisele
authors.forename: J H
authors.initials: JH
authors.lastname: Peter
authors.forename: A R
authors.initials: AR
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007327:Insufflation / Q000295:instrumentation*; D007830:Larynx / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017286:Polysomnography; D012123:Pulmonary Ventilation / Q000502:physiology; D012815:Signal Processing, Computer-Assisted; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D014132:Trachea / Q000503:physiopathology; D014139:Tracheostomy / Q000295:instrumentation*