SLEEP DISORDERED BREATHING

Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea

R C Heinzer^1,2, M L Stanchina³, A Malhotra¹, A S Jordan¹, S R Patel¹, Y-L Lo^1,4, A Wellman¹, K Schory¹, L Dover¹, D P White¹

¹ Sleep Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
² Service de Pneumologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
³ Rhode Island Hospital, Brown Medical School, Providence, RI, USA
⁴ Department of Thoracic Medicine 2, Chang Gang Memorial Hospital, Taipei, Taiwan

Correspondence to:
Dr R C Heinzer
Service de Pneumologie, Unité de Médecine du Sommeil et des troubles respiratoires, 1011 CHUV Lausanne, Switzerland; rheinzer{at}post.harvard.edu

Background: Previous studies have shown that changes in lung volume influence upper airway size and resistance, particularly in patients with obstructive sleep apnoea (OSA), and that continuous positive airway pressure (CPAP) requirements decrease when the lung volume is increased. We sought to determine the effect of a constant lung volume increase on sleep disordered breathing during non-REM sleep.

Methods: Twelve subjects with OSA were studied during non-REM sleep in a rigid head-out shell equipped with a positive/negative pressure attachment for manipulation of extrathoracic pressure. The increase in lung volume due to CPAP (at a therapeutic level) was determined with four magnetometer coils placed on the chest wall and abdomen. CPAP was then stopped and the subjects were studied for 1 hour in three conditions (in random order): (1) no treatment (baseline); (2) at "CPAP lung volume", with the increased lung volume being reproduced by negative extrathoracic pressure alone (lung volume 1, LV1); and (3) 500 ml above the CPAP lung volume(lung volume 2, LV2).

Results: The mean (SE) apnoea/hypopnoea index (AHI) for baseline, LV1, and LV2, respectively, was 62.3 (10.2), 37.2 (5.0), and 31.2 (6.7) events per hour (p = 0.009); the 3% oxygen desaturation index was 43.0 (10.1), 16.1 (5.4), and 12.3 (5.3) events per hour (p = 0.002); and the mean oxygen saturation was 95.4 (0.3)%, 96.0 (0.2)%, 96.3 (0.3)%, respectively (p = 0.001).

Conclusion: An increase in lung volume causes a substantial decrease in sleep disordered breathing in patients with OSA during non-REM sleep.

Abbreviations: AHI, apnoea/hypopnoea index; BMI, body mass index; CPAP, continuous positive airway pressure; EELV, end expiratory lung volume; OSA, obstructive sleep apnoea; REM, rapid eye movement

Keywords: obstructive sleep apnoea; lung volume; continuous positive airway pressure; airflow limitation

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