title: The effect of increased lung volume in chronic obstructive pulmonary disease on upper airway obstruction during sleep.
abstract: Patients with chronic obstructive pulmonary disease (COPD) exhibit increases in lung volume due to expiratory airflow limitation. Increases in lung volumes may affect upper airway patency and compensatory responses to inspiratory flow limitation (IFL) during sleep. We hypothesized that COPD patients have less collapsible airways inversely proportional to their lung volumes, and that the presence of expiratory airflow limitation limits duty cycle responses to defend ventilation in the presence of IFL. We enrolled 18 COPD patients and 18 controls, matched by age, body mass index, sex, and obstructive sleep apnea disease severity. Sleep studies, including quantitative assessment of airflow at various nasal pressure levels, were conducted to determine upper airway mechanical properties [passive critical closing pressure (Pcrit)] and for quantifying respiratory timing responses to experimentally induced IFL. COPD patients had lower passive Pcrit than their matched controls (COPD: -2.8 ± 0.9 cmH2O; controls: -0.5 ± 0.5 cmH2O, P = 0.03), and there was an inverse relationship of subject's functional residual capacity and passive Pcrit (-1.7 cmH2O/l increase in functional residual capacity, r(2) = 0.27, P = 0.002). In response to IFL, inspiratory duty cycle increased more (P = 0.03) in COPD patients (0.40 to 0.54) than in controls (0.41 to 0.51) and led to a marked reduction in expiratory time from 2.5 to 1.5 s (P < 0.01). COPD patients have a less collapsible airway and a greater, not reduced, compensatory timing response during upper airway obstruction. While these timing responses may reduce hypoventilation, it may also increase the risk for developing dynamic hyperinflation due to a marked reduction in expiratory time.
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland; and Hospital Universitário, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Paolo
authors.initials: P
authors.lastname: Biselli
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland; and.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Grossman
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland; and.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Kirkness
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland; and.
authors.forename: Susheel P
authors.initials: SP
authors.lastname: Patil
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland; and.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Smith
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland; and.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Schwartz
authors.affiliation: Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland; and hschnei3@jhmi.edu.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schneider
mesh_terms: D045853:Exhalation; D005105:Expiratory Reserve Volume; D005260:Female; D006801:Humans; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D015656:Respiratory Mechanics; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology*; D013990:Tidal Volume
keywords: COPD; inspiratory flow limitation; lung volume; obstructive sleep apnea; upper airway obstruction