Measurement of gastric P(CO2) as an index of tissue hypoxia during obstructive sleep apnea.
BACKGROUND
Gastric mucosal ischemia develops in critically ill patients in a number of clinical settings due to diversion of blood flow from the splanchnic bed to more vital organs, and can be detected by the measurement of gastric intramucosal pH (pHi).


OBJECTIVE
We hypothesized that similar changes would occur during obstructive sleep apnea (OSA) due to increased respiratory work during the periods of apnea.


METHODS
Gastric P(CO2), pHi and arterial blood gases were measured during 3 conditions in 8 patients with severe OSA: at baseline awake, while asleep with > or = 30 obstructive apneas or hypopneas per hour, and asleep after elimination of apneas with continuous positive airway pressure (CPAP).


RESULTS
Significant changes between the baseline and apnea conditions were detected using ANOVA for repeated measures for gastric P(CO2), 40.2 +/- 5.3 vs. 85.4 +/- 34.0 (p < 0.001), pHi, 7.41 +/- 0.06 vs. 7.11 +/- 0.17 (p < 0.005), and the gastric-arterial P(CO2) difference (D(CO2)), -2.3 +/- 5.5 vs. 44.3 +/- 36.21 (p < 0.006). Nasal CPAP returned all measures back to baseline values.


CONCLUSIONS
Gastric tissue hypoxia develops in patients with severe OSA and may be a marker of disease severity. Treatment of OSA with CPAP eliminates the regional tissue hypoxia.
Department of Pulmonary and Critical Care Medicine, Division of Medicine, Wilford Hall Medical Center, San Antonio, TX, USA. Lawrence_Epstein@sleephealth.com
L J
LJ
Epstein
O J
OJ
Jervis
J H
JH
Henderson
M
M
Sullivan
Z
Z
Mohsenifar
D000136:Acid-Base Equilibrium / Q000502:physiology; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000032:analysis*; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply* / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D000860:Hypoxia / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
D002245:Carbon Dioxide