Dataset Information

Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea.

ABSTRACT:

Rationale

Therapies for obstructive sleep apnea (OSA) could be administered on the basis of a patient's own phenotypic causes ("traits") if a clinically applicable approach were available.

Objectives

Here we aimed to provide a means to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography.

Methods

Based on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive. Thus, measuring ventilation and ventilatory drive (e.g., during spontaneous cyclic events) should reveal a patient's phenotypic traits without specialized intervention. We demonstrate this concept in patients with OSA (N = 29), using a novel automated noninvasive method to estimate ventilatory drive (polysomnographic method) and using "gold standard" ventilatory drive (intraesophageal diaphragm EMG) for comparison. Specialized physiological measurements using continuous positive airway pressure manipulation were employed for further comparison. The validity of nasal pressure as a ventilation surrogate was also tested (N = 11).

Measurements and main results

Polysomnography-derived collapsibility and compensation estimates correlated favorably with those quantified using gold standard ventilatory drive (R = 0.83, P < 0.0001; and R = 0.76, P < 0.0001; respectively) and using continuous positive airway pressure manipulation (R = 0.67, P < 0.0001; and R = 0.64, P < 0.001; respectively). Polysomnographic estimates effectively stratified patients into high versus low subgroups (accuracy, 69-86% vs. ventilatory drive measures; P < 0.05). Traits were near-identical using nasal pressure versus pneumotach (N = 11, R ≥ 0.98, both traits; P < 0.001).

Conclusions

Phenotypes of pharyngeal dysfunction in OSA are evident from spontaneous changes in ventilation and ventilatory drive during sleep, enabling noninvasive phenotyping in the clinic. Our approach may facilitate precision therapeutic interventions for OSA.

SUBMITTER: Sands SA

PROVIDER: S-EPMC6019932 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Publications

Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea.

Sands Scott A SA Edwards Bradley A BA Terrill Philip I PI Taranto-Montemurro Luigi L Azarbarzin Ali A Marques Melania M Hess Lauren B LB White David P DP Wellman Andrew A

American journal of respiratory and critical care medicine 20180501 9

<h4>Rationale</h4>Therapies for obstructive sleep apnea (OSA) could be administered on the basis of a patient's own phenotypic causes ("traits") if a clinically applicable approach were available.<h4>Objectives</h4>Here we aimed to provide a means to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography.<h4>Methods</h4>Based on physiological definitions, pharyngeal collapsibility determines the venti ...[more]

PMID: 29327943

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Project description:Background/Objectives: Factors underlying excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) are not fully understood. We investigated whether polysomnography (PSG) parameters differed between non-sleepy and sleepy (based on the Epworth Sleepiness Scale (ESS)) OSA patients with the same disease severity, which may play a role in the presence of EDS. Methods: A total of 1307 patients, without cardiovascular, metabolic, respiratory, or inflammatory comorbidities, diagnosed with OSA (apnea-hypopnea index (AHI) ≥ 5 per hour of sleep) with type 1 PSG were included. Based on the AHI, patients were classified into mild- (AHI 5-14.9, n = 236), moderate- (AHI 15-29.9, n = 367), and severe-OSA (AHI ≥ 30, n = 704) groups. These groups were further divided into two subgroups based on the ESS, the most convenient and widely used tool to assess excessive daytime sleepiness: sleepy (ESS > 10) and non-sleepy (ESS ≤ 10). PSG data were compared between groups, and multivariable logistic regression was used to identify differences after adjustment for confounders. Results: For the entire population, male sex, younger age, obesity, depression, increased wakefulness after sleep onset (WASO), the arousal index, shorter sleep latency, and all indices of OSA severity (AHI, oxygen desaturation index, mean and lowest resting room air pulse oximetry (SpO2), and sleep time with oxygen saturation < 90% (TST90)) were significantly associated with EDS. The arousal index consistently showed a strong association with EDS across all OSA severity groups. Moderate-OSA sleepy patients were younger, with shorter sleep latency and increased indices of OSA severity, excluding the AHI. Severe-OSA sleepy patients were younger, males, and obese; had depression, decreased slow-wave sleep (SWS) and sleep latency, and increased WASO; and presented an increase in all indices of OSA severity. Conclusions: Our results suggest that male sex, younger age, obesity, the presence of depression, WASO, lower sleep efficiency, the arousal index, and all indices of OSA severity may account for the presence or absence of EDS in OSA patients and could be useful for exploring the underlying pathophysiological mechanisms for precision medicine.

Dataset Information

Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea.

Rationale

Objectives

Methods

Measurements and main results

Conclusions

Publications

Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea.

Similar Datasets

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