Breath-holding as a means to estimate the loop gain contribution to obstructive sleep apnoea
Carregando...
Citações na Scopus
38
Tipo de produção
article
Data de publicação
2018
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
MESSINEO, Ludovico
TARANTO-MONTEMURRO, Luigi
AZARBARZIN, Ali
CALIANESE, Nicole
WHITE, David P.
WELLMAN, Andrew
SANDS, Scott A.
Citação
JOURNAL OF PHYSIOLOGY-LONDON, v.596, n.17, p.4043-4056, 2018
Resumo
Increased ""loop gain"" of the ventilatory control system promotes obstructive sleep apnoea (OSA) in some patients and offers an avenue for more personalized treatment, yet diagnostic tools for directly measuring loop gain in the clinical setting are lacking. Here we test the hypothesis that elevated loop gain during sleep can be recognized using voluntary breath-hold manoeuvres during wakefulness. Twenty individuals (10 OSA, 10 controls) participated in a single overnight study with voluntary breath-holding manoeuvres performed during wakefulness. We assessed (1) maximal breath-hold duration, and (2) the ventilatory response to 20 s breath-holds. For comparison, gold standard loop gain values were obtained during non-rapid eye movement (non-REM) sleep using the ventilatory response to 20 s pulses of hypoxic-hypercapnic gas (6% CO2-14% O-2, mimicking apnoea). Continuous positive airway pressure (CPAP) was used to maintain airway patency during sleep. Additional measurements included gold standard loop gain measurement during wakefulness and steady-state loop gain measurement during sleep using CPAP dial-ups. Higher loop gain during sleep was associated with (1) a shorter maximal breath-hold duration (r(2) = 0.49, P < 0.001), and (2) a larger ventilatory response to 20 s breath-holds during wakefulness (second breath; r(2) = 0.50, P < 0.001); together these factors combine to predict high loop gain (receiver operating characteristic area-under-curve: 92%). Gold standard loop gain values were remarkably similar during wake and non-REM sleep. The results show that elevated loop gain during sleep can be identified using simple breath-holding manoeuvres performed during wakefulness. This may have implications for personalizing OSA treatment.
Palavras-chave
OSA alternative treatments, OSA phenotyping, chemoreflex predictors
Referências
- Berry RB, 2012, J CLIN SLEEP MED, V8, P597, DOI 10.5664/jcsm.2172
- BLAIR E, 1955, J CLIN INVEST, V34, P383, DOI 10.1172/JCI103086
- Carroll MS, 2014, J APPL PHYSIOL, V116, P439, DOI 10.1152/japplphysiol.01310.2013
- Doff MHJ, 2013, SLEEP, V36, P1289, DOI 10.5665/sleep.2948
- DOUGLAS NJ, 1982, AM REV RESPIR DIS, V126, P758
- Eckert DJ, 2013, AM J RESP CRIT CARE, V188, P996, DOI 10.1164/rccm.201303-0448OC
- Edwards BA, 2016, AM J RESP CRIT CARE, V194, P1413, DOI 10.1164/rccm.201601-0099OC
- Edwards BA, 2016, SLEEP, V39, P1973, DOI 10.5665/sleep.6226
- Edwards BA, 2014, J PHYSIOL-LONDON, V592, P4523, DOI 10.1113/jphysiol.2014.277210
- Edwards BA, 2013, SLEEP, V36, P281, DOI 10.5665/sleep.2390
- Edwards BA, 2012, J PHYSIOL-LONDON, V590, P1199, DOI 10.1113/jphysiol.2011.223925
- FINDLEY LJ, 1983, J APPL PHYSIOL, V55, P1777
- Flemons WW, 1999, SLEEP, V22, P667
- Fu YQ, 2017, SLEEP BREATH, V21, P181, DOI 10.1007/s11325-016-1393-1
- Furlow B, 2016, LANCET RESP MED, V4, P860, DOI 10.1016/S2213-2600(16)30300-9
- Ghazanshahi SD, 1997, IEEE T BIO-MED ENG, V44, P357, DOI 10.1109/10.568911
- Giannoni A, 2009, J AM COLL CARDIOL, V53, P1975, DOI 10.1016/j.jacc.2009.02.030
- Heinzer RC, 2005, AM J RESP CRIT CARE, V172, P114, DOI 10.1164/rccm.200404-522OC
- Hill L, 1908, J PHYSIOL-LONDON, V37, P77
- Horner RL, 2001, J PHYSIOL-LONDON, V534, P881, DOI 10.1111/j.1469-7793.2001.00881.x
- Hudgel DW, 1998, AM J RESP CRIT CARE, V158, P1142, DOI 10.1164/ajrccm.158.4.9712105
- Javaheri S, 1999, NEW ENGL J MED, V341, P949, DOI 10.1056/NEJM199909233411304
- Joosten SA, 2017, SLEEP, V40, DOI 10.1093/sleep/zsx094
- KELMAN GR, 1971, Q J EXP PHYSIOL CMS, V56, P92, DOI 10.1113/expphysiol.1971.sp002111
- Loewen A, 2009, SLEEP, V32, P1355, DOI 10.1093/sleep/32.10.1355
- MCCLEAN PA, 1988, J APPL PHYSIOL, V64, P84
- Messineo L, 2017, SLEEP BREATH, V21, P861, DOI 10.1007/s11325-017-1485-6
- Nikita T, 2017, RESP PHYSIOL NEUROBI, V235, P79, DOI 10.1016/j.resp.2016.10.005
- Parkes MJ, 2006, EXP PHYSIOL, V91, P1, DOI 10.1113/expphysiol.2005.031625
- SANDS SA, 2017, AM J RESP CRIT CARE, V195
- Sands SA, 2017, AM J RESP CRIT CARE, V195, P237, DOI [10.1164/rccm.201604-07610C, 10.1164/rccm.201604-0761OC]
- SERIES F, 1989, EUR RESPIR J, V2, P26
- SHEA SA, 1993, RESP PHYSIOL, V93, P203, DOI 10.1016/0034-5687(93)90006-V
- Solin P, 2000, AM J RESP CRIT CARE, V162, P2194, DOI 10.1164/ajrccm.162.6.2002024
- STANLEY NN, 1975, THORAX, V30, P337, DOI 10.1136/thx.30.3.337
- Strollo PJ, 2014, NEW ENGL J MED, V370, P139, DOI 10.1056/NEJMoa1308659
- Taranto-Montemurro L, 2016, EUR RESPIR J, V48, P1340, DOI 10.1183/13993003.00823-2016
- Terrill PI, 2015, EUR RESPIR J, V45, P408, DOI 10.1183/09031936.00062914
- Wellman A, 2008, RESP PHYSIOL NEUROBI, V162, P144, DOI 10.1016/j.resp.2008.05.019
- Wellman A, 2013, J APPL PHYSIOL, V114, P911, DOI 10.1152/japplphysiol.00747.2012
- Wellman A, 2011, J APPL PHYSIOL, V110, P1627, DOI 10.1152/japplphysiol.00972.2010
- WHITE DP, 1986, J APPL PHYSIOL, V61, P1279
- Xie AL, 2013, J APPL PHYSIOL, V115, P22, DOI 10.1152/japplphysiol.00064.2013
- Younes M, 2001, AM J RESP CRIT CARE, V163, P1181, DOI 10.1164/ajrccm.163.5.2007013
- Younes M, 2007, J APPL PHYSIOL, V103, P1929, DOI 10.1152/japplphysiol.00561.2007