Induction of periodic breathing during sleep causes upper airway obstruction in humans

1986 ◽  
Vol 61 (4) ◽  
pp. 1438-1443 ◽  
Author(s):  
E. Onal ◽  
D. L. Burrows ◽  
R. H. Hart ◽  
M. Lopata
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Nrem Sleep ◽  
Upper Airway Obstruction ◽  
Respiratory Pattern ◽  
Normal Male ◽  
Added Resistance ◽  
Upper Airways ◽  
Resistive Loading

To test the hypothesis that occlusive apneas result from sleep-induced periodic breathing in association with some degree of upper airway compromise, periodic breathing was induced during non-rapid-eye-movement (NREM) sleep by administering hypoxic gas mixtures with and without applied external inspiratory resistance (9 cmH2O X l-1 X s) in five normal male volunteers. In addition to standard polysomnography for sleep staging and respiratory pattern monitoring, esophageal pressure, tidal volume (VT), and airflow were measured via an esophageal catheter and pneumotachograph, respectively, with the latter attached to a tight-fitting face mask, allowing calculation of total pulmonary system resistance (Rp). During stage I/II NREM sleep minimal period breathing was evident in two of the subjects; however, in four subjects during hypoxia and/or relief from hypoxia, with and without added resistance, pronounced periodic breathing developed with waxing and waning of VT, sometimes with apneic phases. Resistive loading without hypoxia did not cause periodicity. At the nadir of periodic changes in VT, Rp was usually at its highest and there was a significant linear relationship between Rp and 1/VT, indicating the development of obstructive hypopneas. In one subject without added resistance and in the same subject and in another during resistive loading, upper airway obstruction at the nadir of the periodic fluctuations in VT was observed. We conclude that periodic breathing resulting in periodic diminution of upper airway muscle activity is associated with increased upper airway resistance that predisposes upper airways to collapse.

scholarly journals Compensatory responses to upper airway obstruction in obese apneic men and women

2012 ◽  
Vol 112 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Chien-Hung Chin ◽  
Jason P. Kirkness ◽  
Susheel P. Patil ◽  
Brian M. McGinley ◽  
Philip L. Smith ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Rem Sleep ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Upper Airway Obstruction ◽  
Men And Women ◽  
Compensatory Responses ◽  
Obstructive Sleep

Defective structural and neural upper airway properties both play a pivotal role in the pathogenesis of obstructive sleep apnea. A more favorable structural upper airway property [pharyngeal critical pressure under hypotonic conditions (passive Pcrit)] has been documented for women. However, the role of sex-related modulation in compensatory responses to upper airway obstruction (UAO), independent of the passive Pcrit, remains unclear. Obese apneic men and women underwent a standard polysomnography and physiological sleep studies to determine sleep apnea severity, passive Pcrit, and compensatory airflow and respiratory timing responses to prolonged periods of UAO. Sixty-two apneic men and women, pairwise matched by passive Pcrit, exhibited similar sleep apnea disease severity during rapid eye movement (REM) sleep, but women had markedly less severe disease during non-REM (NREM) sleep. By further matching men and women by body mass index and age ( n = 24), we found that the lower NREM disease susceptibility in women was associated with an approximately twofold increase in peak inspiratory airflow ( P = 0.003) and inspiratory duty cycle ( P = 0.017) in response to prolonged periods of UAO and an ∼20% lower minute ventilation during baseline unobstructed breathing (ventilatory demand) ( P = 0.027). Thus, during UAO, women compared with men had greater upper airway and respiratory timing responses and a lower ventilatory demand that may account for sex differences in sleep-disordered breathing severity during NREM sleep, independent of upper airway structural properties and sleep apnea severity during REM sleep.

scholarly journals Leptin receptor expression in the dorsomedial hypothalamus stimulates breathing during NREM sleep in db/db mice

SLEEP ◽  
2021 ◽  
Author(s):  
Huy Pho ◽  
Slava Berger ◽  
Carla Freire ◽  
Lenise J Kim ◽  
Mi-Kyung Shin ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Leptin Receptor ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Upper Airway Obstruction ◽  
Co2 Production ◽  
Dorsomedial Hypothalamus ◽  
Leptin Signaling ◽  
Arterial Blood ◽  
Obesity Hypoventilation

Abstract Study Objectives Obesity leads to obstructive sleep apnea (OSA), which is recurrent upper airway obstruction during sleep, and obesity hypoventilation syndrome (OHS), hypoventilation during sleep resulting in daytime hypercapnia. Impaired leptin signaling in the brain was implicated in both conditions, but mechanisms are unknown. We have previously shown that leptin stimulates breathing and treats OSA and OHS in leptin- deficient ob/ob mice and leptin-resistant diet-induced obese mice and that leptin’s respiratory effects may occur in the dorsomedial hypothalamus (DMH). We hypothesized that leptin receptor LepR b–deficient db/db mice have obesity hypoventilation and that restoration of leptin signaling in the DMH will increase ventilation during sleep in these animals. Methods We measured arterial blood gas in unanesthetized awake db/db mice. We subsequently infected these animals with Ad-LepR  b or control Ad-mCherry virus into the DMH and measured ventilation during sleep as well as CO2 production after intracerebroventricular (ICV) infusions of phosphate-buffered saline or leptin. Results Awake db/db mice had elevated CO2 levels in the arterial blood. Ad-LepR  b infection resulted in LepR  b expression in the DMH neurons in a similar fashion to wildtype mice. In LepR  b-DMH db/db mice, ICV leptin shortened REM sleep and increased inspiratory flow, tidal volume and minute ventilation during NREM sleep without any effect on the quality of NREM sleep or CO2 production. Leptin had no effect on upper airway obstruction in these animals. Conclusion Leptin stimulates breathing and treats obesity hypoventilation acting on LepR b-positive neurons in the DMH.

Mouth and nose resistance in newborn kittens and puppies

1981 ◽  
Vol 51 (3) ◽  
pp. 641-645 ◽  
Author(s):  
J. P. Mortola ◽  
J. T. Fisher
Keyword(s):  
Mechanical Properties ◽  
Airway Obstruction ◽  
Flow Rate ◽  
Muscle Tone ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Upper Airways ◽  
Airway Patency ◽  
The Difference ◽  
Adult Cats

Newborn mammals, including infants, have difficulties in mouth breathing when the nasal passages are occluded. In this study we examined the possibility that differences in the passive mechanical properties of the upper airways could fully explain this behavior. Steady inspiratory flows through the upper airways in anesthetized supine newborn kittens and puppies resulted in upper airway obstruction, even at flows less than those occurring during resting breathing, suggesting that in the unanesthetized condition muscle tone plays an important role in maintaining upper airway patency. Mouth (Rm) and nose (Rn) resistances have been measured during steady expiratory flows with nostrils closed and mouth passively open or nostrils open and mouth closed. In all the newborns, Rn was substantially smaller than Rm. In contrast, the Rn/Rm in adult dogs is greater than unity. In adult cats Rn/Rm is above or below unity depending upon the flow rate, but the ratio is always larger than in newborn kittens. The difference between newborns and adults is entirely due to the small Rn of the newborn, as Rm is not greater in the newborn than in the adult. We conclude that the obligatory nose breathing behavior of newborns is not fully explained by the passive mechanical properties of the upper airways.

Upper airway obstruction induced by negative-pressure ventilation in awake healthy subjects

1993 ◽  
Vol 75 (2) ◽  
pp. 546-552 ◽  
Author(s):  
A. Sanna ◽  
C. Veriter ◽  
D. Stanescu
Keyword(s):  
Airway Obstruction ◽  
Negative Pressure ◽  
Healthy Subjects ◽  
Fiber Optic ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Bipolar Electrode ◽  
Upper Airways ◽  
Negative Pressure Ventilation ◽  
Zero Values

Negative-pressure ventilation (NPV) induces sleep-related upper airway obstruction. However, the precise mechanism and site of upper airway obstruction during NPV have not been worked out. We studied seven awake healthy volunteers (23–30 yr old) in an Emerson tank respirator. Subjects had the head outside the iron lung and breathed through a pneumotachograph, which yielded the airflow (V) signal. Supraglottic pressure (Psg) was measured with a catheter with the tip at the retroepiglottic level. Diaphragmatic electromyograms (EMGdi) were obtained from an esophageal bipolar electrode. Tidal volume was measured with an inductance plethysmograph. Measurements were done at -10, -20, and -30 cmH2O. At each pressure run subjects were asked to repeatedly relax or to actively breathe in phase with the respirator. Subjects had been previously trained to relax during NPV. During the relax runs there was no EMGdi activity. Stridor or wheezing occurred in all seven subjects during the relax runs but not during the active runs. Two patterns were associated with NPV during relax runs. One pattern was decreases in both V and Psg followed by zero values of these indexes, which corresponded to an inspiratory narrowing and closure of the glottis. These changes were visualized by fiber-optic bronchoscopy in one subject. The second pattern was a decrease in V and increase in Psg, which corresponded to an inspiratory supraglottic obstruction. In five subjects a supraglottic pattern was observed, whereas in two subjects glottic closure was seen. We conclude that muscular relaxation during NPV produces a decrease in the caliber of the upper airways at the glottic or supraglottic level. An uncoupling of upper airway muscle activity and the diaphragm might be the mechanism responsible for these changes.

Hypersomnia with Periodic Breathing (An Acromegalic Pickwickian)

1978 ◽  
Vol 86 (6) ◽  
pp. ORL-897-ORL-903 ◽  
Author(s):  
Bruce J. Romanczuk ◽  
William P. Potsic ◽  
Joseph P. Atkins
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Upper Airway Obstruction ◽  
Laryngeal Stenosis ◽  
Respiratory Disorders ◽  
Ondine’S Curse ◽  
Alveolar Hypoventilation ◽  
Respiratory Rhythms ◽  
Multiple Variants

The syndromes of Pickwickian, Ondine's curse, and primary alveolar hypoventilation are respiratory disorders manifesting increased sleepiness and irregular respiratory rhythms. These disorders are currently grouped as hypersomnia with periodic breathing (HPB). Polygraphic techniques have lead to a reasonable hypothesis as to the pathophysiology of the multiple variants of HPB. Discernible causes of HPB have been attributed to both central and peripheral factors. Peripheral factors encompass those conditions relating to upper airway obstruction. An acromegalic person suffering the HPB syndrome secondary to laryngeal stenosis is described.

scholarly journals Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Macario Camacho ◽  
Justin M. Wei ◽  
Lauren K. Reckley ◽  
Sungjin A. Song
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Nasal Surgery ◽  
Upper Airways ◽  
Obstructive Sleep

Objectives. During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place. Materials and Methods. The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results. The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations. Conclusions. The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.

scholarly journals Unusual presentation of ectopic thyroid causing respiratory distress

2020 ◽  
Vol 6 (6) ◽  
pp. 1188
Author(s):  
Sunil Kathuria ◽  
Chikku Sunny
Keyword(s):  
Airway Obstruction ◽  
English Literature ◽  
Thyroid Tissue ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Ectopic Thyroid ◽  
Respiratory Obstruction ◽  
Upper Airways ◽  
Ectopic Thyroid Tissue ◽  
Foreign Body Inhalation

<p>Internal obstruction of the upper airways can be due to infection, anaphylactic reaction, congenital anomaly, foreign body inhalation or mass. The endoluminal presence of thyroid tissue in the trachea is a rare cause of airway obstruction. Only 14 well documented cases of intratracheal ectopic thyroid tissue have been reported in English literature since 1966. These lesions are mostly benign and nearly all patient present with symptoms of respiratory obstruction. This case report is of a lady who presented with upper airway obstruction due to subglottic ectopic thyroid tissue. An ectopic thyroid gland can develop if its normal migration is halted along this tract during embryogenesis. Subglottic location of ectopic thyroid is extremely rare. However, ectopic thyroid tissue in the larynx should be considered as a possible diagnosis causing upper airway obstruction.</p>

scholarly journals Leptin receptor expression in the dorsomedial hypothalamus stimulates breathing during NREM sleep in db/db mice

2020 ◽  
Author(s):  
Huy Pho ◽  
Slava Berger ◽  
Carla Freire ◽  
Lenise J Kim ◽  
Mi-Kyung Shin ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Leptin Receptor ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Receptor Expression ◽  
Upper Airway Obstruction ◽  
Dorsomedial Hypothalamus ◽  
Obstructive Sleep ◽  
Alveolar Hypoventilation

ABSTRACTObesity can lead to recurrent upper airway obstruction (obstructive sleep apnea, OSA) during sleep as well as alveolar hypoventilation. We have previously shown that leptin stimulates breathing and treats OSA in leptin-deficient ob/ob mice and leptin-resistant diet-induced obese mice. Our previous data also suggest that leptin’s respiratory effects may occur in the dorsomedial hypothalamus (DMH). We selectively expressed leptin receptor LepRb in the DMH neurons of obese LepRb-deficient db/db mice (LepRb-DMH mice), which hypoventilate at baseline, and showed that intracerebroventricular injection of leptin in these animals increased inspiratory flow, tidal volume and minute ventilation during NREM sleep without any effect on the quality of NREM sleep or CO2 production. Leptin had no effect on upper airway obstruction in LepRb-DMH animals. We conclude that leptin stimulates breathing and treats obesity related hypoventilation acting on LepRb-positive neurons in the DMH.

ID: 127: DECREASED CPAP ADHERENCE IN NON-OBESE OSA PATIENTS WITH REVERSIBLE UPPER AIRWAY OBSTRUCTION

2016 ◽  
Vol 64 (4) ◽  
pp. 970.1-970
Author(s):  
J Doumit ◽  
P Belvitch ◽  
I Rubinstein
Keyword(s):  
Airway Obstruction ◽  
Airway Resistance ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Beta Agonist ◽  
Upper Airways ◽  
Short Acting ◽  
Cpap Adherence ◽  
Upper Airway Resistance ◽  
Airways Obstruction

RationaleUpper airway resistance is critical to the pathophysiology of obstructive sleep apnea (OSA). We have previously characterized a subset of patients with OSA who have evidence of reversible upper airways resistance as measured by spirometry. Specifically, these patients have an increased FEF50/FIF50 ratio which decreases with administration of a short acting bronchodilator. On average these patients had a lower BMI (average 27) compared to OSA patients as a whole suggesting the possibility of unique upper airway pathophysiology among this group. In the current study, we identify additional patients with OSA who have reversible upper airways obstruction on spirometry and characterize their compliance with CPAP therapy as compared to a traditional OSA population.MethodsWe retrospectively evaluated patients who had a sleep screen suggestive of OSA in the last 2 years. Patients who also had spirometry in the previous 5 years were identified for further analysis. Those patients with either normal spirometry or fixed obstructive defects who had a decrease in the FEF50/FIF50 ratio after administration of a short acting inhaled beta agonist (albuterol) were then characterized. We then measured objective CPAP adherence using data downloaded from the positive airway pressure device with adherence defined as CPAP use >4 hrs more than 70% of nights over a 30 day period.ResultsWe identified 70 patients with positive sleep screens who also had spirometry demonstrating normal of fixed lower expiratory obstruction with evidence of upper airways obstruction as demonstrated by a decreased FEF50/FIF50 ratio. Of these, 45 had a decrease in the FEF50/FIF50 ratio of more than 20% following administration of inhaled albuterol. Overall, CPAP adherence between those with reversible upper airways obstruction and those without was similar (23/45=51% vs 14/26=54%). However, subgroup analysis revealed a lower adherence rate among non-obese patients (BMI<30) with reversible airways obstruction (6/16=36%).ConclusionThe identification of a subset of patients with OSA who have evidence of decreased upper airway resistance in response to inhaled bronchodilator suggests unique pathology in this group. Decreased adherence to traditional OSA therapy with CPAP among these patients is additional evidence of differential pathophysiology requiring novel treatments. Specifically, treatment with a long acting beta agonist (LABA) prior to sleep may reduce upper airway obstruction and be better tolerated than CPAP.

Site of Upper Airway Obstruction in Infants Following an Acute Life-Threatening Event

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 595-601
Author(s):  
N. R. Ruggins ◽  
A. D. Milner
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Upper Airway Obstruction ◽  
Vocal Cords ◽  
Life Threatening ◽  
Life Threatening Event

Twenty-five patients were screened following an acute life-threatening event for the presence of obstructive and mixed apnea. Simultaneous cardiorespiratory monitoring with fiberoptic laryngoscopy was performed to identify the site of upper airway obstruction during these episodes. In 3 of these subjects, who had been born prematurely, obstruction was observed at the laryngeal level, with the arytenoid masses and aryepiglottic folds closing over across the vocal cords. Such closure was also observed during periodic breathing, which was found to be prominent in 4 of the infants studied. The possible role of laryngeal reflexes as a mechanism for these events is discussed.

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