The effect of CPAP on the upper airway and ventilatory flow in patients with obstructive sleep apnea

Respiratory Research

Correspondence

Eli Van de Perck¹  Karlien Van den Bossche¹  Elahe Kazemeini¹  Sara Op de Beeck²  Olivier M Vanderveken²  Johan Verbraecken³  Marc Willemen⁴ 

[1] Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 – D.T.494, Wilrijk, Belgium;Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium;Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 – D.T.494, Wilrijk, Belgium;Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium;Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium;Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 – D.T.494, Wilrijk, Belgium;Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium;Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium;Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium;

关键词: Airflow;    DISE;    Endoscopy;    Epiglottis;    Larynx;    OSA;    Positive airway pressure.;   

DOI  :  10.1186/s12931-023-02452-z

 received in 2022-03-20, accepted in 2023-05-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundContinuous positive airway pressure (CPAP) is the mainstay of treatment for obstructive sleep apnea (OSA). However, data about its effect on the upper airway, especially the epiglottis, are scarce. The aim of this study was to investigate the changes in upper airway dimensions and inspiratory flow in response to incremental pressure levels.MethodsThis is a secondary analysis of a prospective clinical trial in which patients with moderate to severe OSA underwent drug-induced sleep endoscopy with simultaneous recordings of flow and mask pressure. CPAP was titrated in small increments. For each pressure level a representative 3-breath segment was selected to determine specific flow features. The corresponding endoscopic footage was reviewed to assess the degree of upper airway collapse in a semi-quantitative manner.ResultsA total of 214 breath segments were obtained from 13 participants (median [Q1–Q3]; apnea-hypopnea index, 24.9 [20.1–43.9] events/h; body mass index 28.1 [25.1–31.7] kg/m²). CPAP significantly increased cross-sectional dimensions of the soft palate, lateral walls and tongue base, but not of the epiglottis, and induced epiglottis collapse in one subject. Increased pressure improved peak inspiratory flow and median ventilation in all patients, even in the presence of persistent epiglottis collapse.ConclusionCPAP does not effectively address epiglottis collapse in patients with OSA. However, it normalizes inspiratory flow regardless of its effect on the epiglottis. This clinical trial was registered on January 18th, 2020 on ClinicalTrials.gov with identifier NCT04232410.

【 授权许可】

CC BY   
© The Author(s) 2023

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